Individual
MRS. LISA RAE BLANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS/CCC-SLP
Contact information
Practice address
N3995 ANNEX RD, JEFFERSON, WI 53549-9618
(920) 674-7386
(920) 674-6694
Mailing address
W2579 HALE RD, NEOSHO, WI 53059-9522
(920) 625-3147
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1265-154
WI
Other
Enumeration date
09/04/2006
Last updated
07/08/2007
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