Provider Demographics
NPI:1235675216
Name:TEEPLE, LISA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TEEPLE
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 1:12820 REDWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685
Mailing Address - Country:US
Mailing Address - Phone:330-961-7632
Mailing Address - Fax:
Practice Address - Street 1:2100 38TH STREET NW
Practice Address - Street 2:STARK COUNTY EDUCATIONAL SERVICE CENTER
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709
Practice Address - Country:US
Practice Address - Phone:330-492-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.5011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist