Provider Demographics
NPI:1801185319
Name:STIMLEY, LISA LINN (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LINN
Last Name:STIMLEY
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5316
Mailing Address - Country:US
Mailing Address - Phone:812-299-9900
Mailing Address - Fax:812-299-9902
Practice Address - Street 1:1450 E CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5316
Practice Address - Country:US
Practice Address - Phone:812-299-9900
Practice Address - Fax:812-299-9902
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001201A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INLS3291Medicare PIN