Provider Demographics
NPI:1477086858
Name:MANLOVE, LISA J
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:MANLOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:MANLOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA SLP-CCC
Mailing Address - Street 1:1400 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4288
Mailing Address - Country:US
Mailing Address - Phone:918-423-1267
Mailing Address - Fax:
Practice Address - Street 1:1400 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4288
Practice Address - Country:US
Practice Address - Phone:918-423-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist