Provider Demographics
NPI:1740327998
Name:DAVIDSON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAVIDSON
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 1:8 WHITE PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2037
Mailing Address - Country:US
Mailing Address - Phone:636-536-7459
Mailing Address - Fax:
Practice Address - Street 1:4560 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1502
Practice Address - Country:US
Practice Address - Phone:314-977-0127
Practice Address - Fax:314-977-0016
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01722231H00000X, 231HA2400X, 231HA2500X
MO000880237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist