Provider Demographics
NPI:1316098684
Name:STILLE, LISA J (MA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:STILLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:ZUBROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:402-452-5000
Practice Address - Fax:402-452-5028
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE236231H00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06609OtherBCBS BT
NE100251703-00Medicaid
IA3588186Medicaid
IA0588186Medicaid
IA2588186Medicaid
NE100251704-00Medicaid
NE06617OtherBCBS ENT
IA1588186Medicaid