Provider Demographics
NPI:1760915284
Name:PHILLIPI-MILLER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PHILLIPI-MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-6092
Mailing Address - Country:US
Mailing Address - Phone:606-561-6727
Mailing Address - Fax:606-561-0060
Practice Address - Street 1:6141 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6092
Practice Address - Country:US
Practice Address - Phone:606-561-6727
Practice Address - Fax:606-561-0060
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168220237700000X
IN17001449A237700000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0969480OtherORGANIZATION NUMBER