Provider Demographics
NPI:1528899549
Name:YODER-DUBUS, LISA A
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:YODER-DUBUS
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 1:3162 HWY 6
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661
Mailing Address - Country:US
Mailing Address - Phone:254-213-6924
Mailing Address - Fax:
Practice Address - Street 1:ROSEBUD-LOTT ELEMENTARY SCHOOL
Practice Address - Street 2:1813 US-77
Practice Address - City:LOTT
Practice Address - State:TX
Practice Address - Zip Code:76656
Practice Address - Country:US
Practice Address - Phone:254-583-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist