Provider Demographics
NPI:1780715276
Name:RISINGER, LOIS ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:RISINGER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MOORINGS DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1052
Mailing Address - Country:US
Mailing Address - Phone:708-448-9420
Mailing Address - Fax:708-448-9420
Practice Address - Street 1:9 MOORINGS DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1052
Practice Address - Country:US
Practice Address - Phone:708-448-9420
Practice Address - Fax:708-448-9420
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01606949OtherBCBS PROVIDER NO