Provider Demographics
NPI:1174865448
Name:POWELL, LISA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 TUSCANY ROSE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8728
Mailing Address - Country:US
Mailing Address - Phone:702-321-9105
Mailing Address - Fax:
Practice Address - Street 1:10450 TUSCANY ROSE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8728
Practice Address - Country:US
Practice Address - Phone:702-321-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist