Provider Demographics
NPI:1740435577
Name:MASSMAN, LISA LOUISE (BSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LOUISE
Last Name:MASSMAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N26111 LEQUE LN
Mailing Address - Street 2:
Mailing Address - City:ETTRICK
Mailing Address - State:WI
Mailing Address - Zip Code:54627-7981
Mailing Address - Country:US
Mailing Address - Phone:608-525-3478
Mailing Address - Fax:608-525-3478
Practice Address - Street 1:1407 ST ANDREWS ST
Practice Address - Street 2:STE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-7981
Practice Address - Country:US
Practice Address - Phone:608-525-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8881-120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator