Provider Demographics
NPI:1417165440
Name:BARDACH, LISA GAYLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GAYLE
Last Name:BARDACH
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:2314 YORKSHIRE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5041
Mailing Address - Country:US
Mailing Address - Phone:734-973-9670
Mailing Address - Fax:734-975-6970
Practice Address - Street 1:2314 YORKSHIRE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5041
Practice Address - Country:US
Practice Address - Phone:734-973-9670
Practice Address - Fax:734-975-6970
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01080132OtherASHA CERTIFICATION