Basic Information
| Provider Information | |||||||||
| NPI: | 1528334117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROOD | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3298 DEPARTMENT | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601220021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987231 | ||||||||
| Practice Location | |||||||||
| Address1: | 137 FLOWER VALLEY SHOPPING CTR | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630331643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148384318 | ||||||||
| FaxNumber: | 3145130197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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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 | 237700000X | 2012009268 | MO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.