Individual
MRS. LISA MARIE COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS-CCC-SLP
Contact information
Practice address
115 E ARNDT ST, FOND DU LAC, WI 54935-2461
(920) 923-7054
(920) 923-7058
Mailing address
PO BOX 94, BROWNSVILLE, WI 53006-0094
(920) 583-3923
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42714000
—
WI
Enumeration date
05/04/2007
Last updated
07/08/2007
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