Basic Information
| Provider Information | |||||||||
| NPI: | 1902099914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIZAK | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 KESSEL CT | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802406 | ||||||||
| FaxNumber: | 6082802707 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 KESSEL CT | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802406 | ||||||||
| FaxNumber: | 6082802707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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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 | 1041C0700X | 7300 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 149007195 | IL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.