Healthcare Provider Details

I. General information

NPI: 1659465672
Provider Name (Legal Business Name): LISA M THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13914 SOUTHEASTERN PKWY STE 303
FISHERS IN
46037-7126
US

IV. Provider business mailing address

13914 SOUTHEASTERN PKWY STE 303
FISHERS IN
46037-7126
US

V. Phone/Fax

Practice location:
  • Phone: 765-643-6961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002315A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: