Provider Demographics
NPI:1730336066
Name:DRAPER, LISA M (MS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:DRAPER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9476
Mailing Address - Country:US
Mailing Address - Phone:716-772-2041
Mailing Address - Fax:
Practice Address - Street 1:4035 QUAKER RD
Practice Address - Street 2:
Practice Address - City:GASPORT
Practice Address - State:NY
Practice Address - Zip Code:14067-9476
Practice Address - Country:US
Practice Address - Phone:716-772-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0086521235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist