Provider Demographics
NPI:1861687865
Name:CRANE, LISA MARIE (CCC/MA SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:CRANE
Suffix:
Gender:F
Credentials:CCC/MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7384
Mailing Address - Country:US
Mailing Address - Phone:217-649-6593
Mailing Address - Fax:833-520-5082
Practice Address - Street 1:2803 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7384
Practice Address - Country:US
Practice Address - Phone:217-649-6593
Practice Address - Fax:833-520-5082
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003459235Z00000X
MI7101006976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist