Individual
LISA M AMBROSIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD CCCASLP
Contact information
Practice address
1715 DOUSMAN ST, GREEN BAY, WI 54303-3211
(920) 405-1414
(920) 405-1462
Mailing address
3200 SHORE DR, MARINETTE, WI 54143-4292
(715) 735-3187
(715) 735-5848
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
399156
WI
235Z00000X
Speech-Language Pathologist
1899154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41147800
—
WI
05
—
42782500
—
WI
Enumeration date
12/31/2005
Last updated
06/19/2020
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