Healthcare Provider Details

I. General information

NPI: 1316862642
Provider Name (Legal Business Name): MRS. LISA LYNN HANSON-ROCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 116
FALL RIVER WI
53932-0116
US

IV. Provider business mailing address

PO BOX 116
FALL RIVER WI
53932-0116
US

V. Phone/Fax

Practice location:
  • Phone: 920-484-3333
  • Fax: 920-484-3600
Mailing address:
  • Phone: 920-484-3333
  • Fax: 920-484-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number16786
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: