Provider Demographics
NPI:1154473544
Name:HARVEY, LISA DIONNE (MS SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIONNE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 WATERS RUN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2529
Mailing Address - Country:US
Mailing Address - Phone:888-273-8628
Mailing Address - Fax:888-273-8628
Practice Address - Street 1:2309 WATERS RUN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2529
Practice Address - Country:US
Practice Address - Phone:888-273-8628
Practice Address - Fax:888-273-8628
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist