Provider Demographics
NPI:1255870648
Name:SCISSON-WILLFORD, LUANN
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:SCISSON-WILLFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 DEARBAUGH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9245
Mailing Address - Country:US
Mailing Address - Phone:419-738-3422
Mailing Address - Fax:
Practice Address - Street 1:1045 DEARBAUGH AVE STE 2
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9245
Practice Address - Country:US
Practice Address - Phone:419-738-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.7230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist