Provider Demographics
NPI:1982669099
Name:COWDREY, LISA R (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:COWDREY
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:BUCKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-6913
Mailing Address - Country:US
Mailing Address - Phone:816-932-1660
Mailing Address - Fax:816-932-1675
Practice Address - Street 1:4200 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-6913
Practice Address - Country:US
Practice Address - Phone:816-932-1660
Practice Address - Fax:816-932-1675
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006198231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100386030AMedicaid
MO335321105Medicaid
KS100386030AMedicaid
MO335321105Medicaid