Provider Demographics
NPI:1871979682
Name:ATCHISON-TAYLOR, LISA M (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ATCHISON-TAYLOR
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1229
Mailing Address - Country:US
Mailing Address - Phone:717-203-0408
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:2830 CAROL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3852
Practice Address - Country:US
Practice Address - Phone:800-531-2204
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004663L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist