Provider Demographics
NPI:1114139532
Name:ESTES, LISA DIANE (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:ESTES
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 1:711 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2514
Mailing Address - Country:US
Mailing Address - Phone:870-247-1289
Mailing Address - Fax:
Practice Address - Street 1:711 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2514
Practice Address - Country:US
Practice Address - Phone:870-247-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist