Provider Demographics
NPI:1235740036
Name:FOGLEMAN, LYSKA (MS CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:LYSKA
Middle Name:
Last Name:FOGLEMAN
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 SHARPESTOWNE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7564
Mailing Address - Country:US
Mailing Address - Phone:850-341-0418
Mailing Address - Fax:866-475-7515
Practice Address - Street 1:1169 SHARPESTOWNE CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7564
Practice Address - Country:US
Practice Address - Phone:850-341-0418
Practice Address - Fax:866-475-7515
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist