Provider Demographics
NPI:1871268235
Name:BILL, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BILL
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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-0014
Mailing Address - Country:US
Mailing Address - Phone:202-270-2388
Mailing Address - Fax:
Practice Address - Street 1:193 ANTONIE AVE N
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:202-270-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical