Provider Demographics
NPI:1285058362
Name:REESE, LISA AMUSSEN
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:AMUSSEN
Last Name:REESE
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 1:2780 JENNINGS WAY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4715
Mailing Address - Country:US
Mailing Address - Phone:385-290-9382
Mailing Address - Fax:
Practice Address - Street 1:2850 RUBY VISTA DR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-1615
Practice Address - Country:US
Practice Address - Phone:775-753-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist