Provider Demographics
NPI:1093367666
Name:LANCE, DEE MISENHEIMER (PHD, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:MISENHEIMER
Last Name:LANCE
Suffix:
Gender:F
Credentials:PHD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DONAGHEY AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72035-5001
Mailing Address - Country:US
Mailing Address - Phone:501-450-5480
Mailing Address - Fax:501-450-5474
Practice Address - Street 1:201 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72035-5001
Practice Address - Country:US
Practice Address - Phone:501-450-5480
Practice Address - Fax:501-450-5474
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist