Healthcare Provider Details

I. General information

NPI: 1063325132
Provider Name (Legal Business Name): LISA BUECHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NORTH ST
STOUGHTON WI
53589-1733
US

IV. Provider business mailing address

186 CHELSEA CT
OREGON WI
53575-3605
US

V. Phone/Fax

Practice location:
  • Phone: 608-877-5404
  • Fax:
Mailing address:
  • Phone: 608-630-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12022164
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: