Provider Demographics
NPI:1336265578
Name:MADISON, LISA A (AUD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MADISON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:PETERSEN-JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9961 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6720
Mailing Address - Country:US
Mailing Address - Phone:909-427-3910
Mailing Address - Fax:909-427-5285
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-3910
Practice Address - Fax:909-427-5285
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU788231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist