=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568937993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA LENZ SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2018
-----------------------------------------------------
Last Update Date | 10/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203A BARKLEY MEMORIAL CENTER
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-472-2071
-----------------------------------------------------
Fax | 402-472-3814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 988102 NEBRASKA MEDICAL CTR
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68198-8102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2177
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------