Provider Demographics
NPI:1609936814
Name:STEPHENS, LISA LEA (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:LEA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:214 E PINE
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-0225
Mailing Address - Country:US
Mailing Address - Phone:360-273-0220
Mailing Address - Fax:360-273-5510
Practice Address - Street 1:214 E PINE STREET
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568
Practice Address - Country:US
Practice Address - Phone:360-273-0220
Practice Address - Fax:360-273-5510
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7138308Medicaid