Provider Demographics
NPI:1316243918
Name:BOEHNLEIN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOEHNLEIN
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 1:501 S HOSPITAL DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-2103
Mailing Address - Country:US
Mailing Address - Phone:913-294-4343
Mailing Address - Fax:
Practice Address - Street 1:501 S HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-2103
Practice Address - Country:US
Practice Address - Phone:913-294-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist