Provider Demographics
NPI:1447251491
Name:KLOP, LISA (AUD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:KLOP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6720
Mailing Address - Country:US
Mailing Address - Phone:207-846-1380
Mailing Address - Fax:207-846-9701
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6720
Practice Address - Country:US
Practice Address - Phone:207-846-1380
Practice Address - Fax:207-846-9701
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP727231H00000X
MEDL20000344237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEUX9927Medicare PIN