Basic Information
| Provider Information | |||||||||
| NPI: | 1104091016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OSWALD | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WHITE POND DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443201127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305721011 | ||||||||
| FaxNumber: | 3305721018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 02/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | A01493 | OH | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 2591904 | 05 | OH | MEDICAID |