Healthcare Provider Details

I. General information

NPI: 1487887907
Provider Name (Legal Business Name): LISA BARLOG BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALL ST
VALPARAISO IN
46383-2512
US

IV. Provider business mailing address

3333 LINCOLN ST
HIGHLAND IN
46322-2171
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-4586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: