Provider Demographics
NPI:1770625113
Name:IRBY, LISA L (AUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:IRBY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7926
Mailing Address - Country:US
Mailing Address - Phone:405-471-5722
Mailing Address - Fax:405-265-1144
Practice Address - Street 1:432 S MUSTANG RD
Practice Address - Street 2:SUITE B
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7312
Practice Address - Country:US
Practice Address - Phone:405-265-1133
Practice Address - Fax:405-265-1144
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK280231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200105800AMedicaid
OK200105800AMedicaid