Provider Demographics
NPI:1093725061
Name:MARSHALL, LISA MISCHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MISCHELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466A EASTERN PLAZA SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-3108
Mailing Address - Country:US
Mailing Address - Phone:423-623-9997
Mailing Address - Fax:423-623-9909
Practice Address - Street 1:466A EASTERN PLAZA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3108
Practice Address - Country:US
Practice Address - Phone:423-623-9997
Practice Address - Fax:423-623-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0100OtherJOHN DEERE TNCARE
TN4106191OtherBCBS
TN0103OtherJOHN DEERE TNCARE