Provider Demographics
NPI:1417095068
Name:GULBRANSON, LISA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:GULBRANSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S. MOPAC EXPY
Mailing Address - Street 2:#228
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1555
Mailing Address - Country:US
Mailing Address - Phone:864-630-1902
Mailing Address - Fax:
Practice Address - Street 1:2301 S. MOPAC EXPY
Practice Address - Street 2:#228
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5822
Practice Address - Country:US
Practice Address - Phone:864-630-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist