Provider Demographics
NPI:1497087043
Name:HOSELTON, LISA CAROLYN (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROLYN
Last Name:HOSELTON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 HUNN RD
Mailing Address - Street 2:
Mailing Address - City:FORISTELL
Mailing Address - State:MO
Mailing Address - Zip Code:63348-2650
Mailing Address - Country:US
Mailing Address - Phone:314-706-2583
Mailing Address - Fax:
Practice Address - Street 1:2232 HUNN RD
Practice Address - Street 2:
Practice Address - City:FORISTELL
Practice Address - State:MO
Practice Address - Zip Code:63348-2650
Practice Address - Country:US
Practice Address - Phone:314-706-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01207231H00000X, 235Z00000X
IL146.001378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist