Provider Demographics
NPI:1023718723
Name:PRANGER, LISA MARIE (PSYD, HSPP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:PRANGER
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4307
Mailing Address - Country:US
Mailing Address - Phone:815-922-4447
Mailing Address - Fax:
Practice Address - Street 1:17640 MORSE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1420
Practice Address - Country:US
Practice Address - Phone:815-446-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043910B103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical