Provider Demographics
NPI:1447550504
Name:BUCHANAN, LISA (SPEECH-LANGUAGE PATH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2310
Mailing Address - Country:US
Mailing Address - Phone:315-265-1067
Mailing Address - Fax:
Practice Address - Street 1:37 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1801
Practice Address - Country:US
Practice Address - Phone:315-267-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist