Healthcare Provider Details

I. General information

NPI: 1740118389
Provider Name (Legal Business Name): LISA MARKLEY LSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PARK AVE
FOSTORIA OH
44830-1455
US

IV. Provider business mailing address

24647 W 3RD ST
GRAND RAPIDS OH
43522-9432
US

V. Phone/Fax

Practice location:
  • Phone: 419-436-4110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number03145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: