Healthcare Provider Details

I. General information

NPI: 1487575098
Provider Name (Legal Business Name): LISA DUBOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W MAIN ST
CONWAY NH
03818-6140
US

IV. Provider business mailing address

PO BOX 2311
CONWAY NH
03818-2311
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-6356
  • Fax:
Mailing address:
  • Phone: 603-986-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number0331
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: