Provider Demographics
NPI:1447007364
Name:WISLOFF, LISE K (BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:LISE
Middle Name:K
Last Name:WISLOFF
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17731 SEED DRILL LN
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-2415
Mailing Address - Country:US
Mailing Address - Phone:210-842-6777
Mailing Address - Fax:
Practice Address - Street 1:5400 MITCHELLDALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-7231
Practice Address - Country:US
Practice Address - Phone:281-715-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6942103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst