Provider Demographics
NPI:1295100469
Name:NIELSEN, LISA KAY (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KAY
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-4101
Mailing Address - Country:US
Mailing Address - Phone:402-727-3169
Mailing Address - Fax:402-727-3044
Practice Address - Street 1:130 E 9TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-4101
Practice Address - Country:US
Practice Address - Phone:402-727-3169
Practice Address - Fax:402-727-3044
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist