Wildmo, Lisa Anne

Wildmo, Lisa Anne is an individual health care provider with primary practice located at 1318 Memorial Dr Ste 201, Bryan TX 77802-5215. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist-Hearing Aid Fitter, which is considered as her primary health care specialty. Wildmo, Lisa Anne can be contacted via phone (979) 776-2088.

Contact Information

Primary practice address
1318 Memorial Dr Ste 201 Bryan TX 77802-5215
Phone: (979) 776-2088
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist-Hearing Aid Fitter 237600000X 51242 Texas

Profile Details

NPI number 1881699007
LBN Legal business name Wildmo, Lisa Anne
Credentials AU.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881699007 NPPES
Texas Other 7040537 AETNA
Texas Other 528479 AETNA

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