Individual
MRS. LISA MARIE CONKLYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
5722 35TH AVE, KENOSHA, WI 53144-4124
(262) 652-6486
Mailing address
5722 35TH AVE, KENOSHA, WI 53144-4124
(262) 652-6486
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2382-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42798400
—
WI
Enumeration date
04/15/2008
Last updated
04/15/2008
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