Provider Demographics
NPI:1053526111
Name:PRATHER, LISA MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:PRATHER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HOBSON RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8139
Mailing Address - Country:US
Mailing Address - Phone:630-305-0537
Mailing Address - Fax:630-305-0433
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 132
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8139
Practice Address - Country:US
Practice Address - Phone:630-305-0537
Practice Address - Fax:630-305-0433
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000612231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210777Medicare ID - Type Unspecified