Provider Demographics
NPI:1053879635
Name:TREPTOW, LISA MARIE
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:TREPTOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 HAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6508
Mailing Address - Country:US
Mailing Address - Phone:815-557-4409
Mailing Address - Fax:
Practice Address - Street 1:1905 HAVENHILL DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-6508
Practice Address - Country:US
Practice Address - Phone:815-557-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician