Provider Demographics
NPI:1447406384
Name:DOUGLAS, LIA R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LIA
Middle Name:R
Last Name:DOUGLAS
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 1:929 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3125
Mailing Address - Country:US
Mailing Address - Phone:251-610-8000
Mailing Address - Fax:251-943-7778
Practice Address - Street 1:316 S MCKENZIE ST STE 101
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1980
Practice Address - Country:US
Practice Address - Phone:251-610-8000
Practice Address - Fax:251-943-7778
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist