Provider Demographics
NPI:1083622070
Name:SPELLS, LISA A (CCCL SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:SPELLS
Suffix:
Gender:F
Credentials:CCCL SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NORTH FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5812
Mailing Address - Country:US
Mailing Address - Phone:615-226-1265
Mailing Address - Fax:877-235-2914
Practice Address - Street 1:611 NORTH FIFTH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5812
Practice Address - Country:US
Practice Address - Phone:615-226-1265
Practice Address - Fax:877-235-2914
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSLP0000001649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4100212OtherBCBST
TN0446680Medicaid
TN0446680Medicaid