Healthcare Provider Details

I. General information

NPI: 1215902903
Provider Name (Legal Business Name): LISA M WALKER MA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE 3RD FLOOR
BOSTON MA
02115-5711
US

IV. Provider business mailing address

45 DWIGHT ST APT 2
BROOKLINE MA
02446-3338
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number711
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: