Provider Demographics
NPI:1215180872
Name:CALLAHAN, LISA LINDSAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LINDSAY
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-2509
Mailing Address - Country:US
Mailing Address - Phone:518-233-0544
Mailing Address - Fax:518-233-0703
Practice Address - Street 1:9 125TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1903
Practice Address - Country:US
Practice Address - Phone:518-328-0220
Practice Address - Fax:518-328-0224
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0174891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist