Provider Demographics
NPI:1558762179
Name:MERRYMAN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MERRYMAN
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 1:4524 DEER SHADOW TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9728
Mailing Address - Country:US
Mailing Address - Phone:712-454-0001
Mailing Address - Fax:
Practice Address - Street 1:1723 HIGHWAY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2208
Practice Address - Country:US
Practice Address - Phone:712-264-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001070237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist