Provider Demographics
NPI:1306092168
Name:BECKER, LISA MARIE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:BECKER
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 1:2441 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2216
Mailing Address - Country:US
Mailing Address - Phone:765-474-1795
Mailing Address - Fax:765-474-1796
Practice Address - Street 1:2441 E STATE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2216
Practice Address - Country:US
Practice Address - Phone:765-474-1795
Practice Address - Fax:765-474-1796
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26-29943801744R1103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder