Provider Demographics
NPI:1821427337
Name:LEVIN, LISA (HIS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MCCOLLUM ST STE 107
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5151
Mailing Address - Country:US
Mailing Address - Phone:307-742-4327
Mailing Address - Fax:
Practice Address - Street 1:204 MCCOLLUM ST STE 107
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5151
Practice Address - Country:US
Practice Address - Phone:307-742-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY175237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist