Provider Demographics
NPI:1649721317
Name:SCHIPPERS, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SCHIPPERS
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 1092
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:314-750-0068
Practice Address - Street 1:12400 OLIVE BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5454
Practice Address - Country:US
Practice Address - Phone:314-750-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160337324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist