Provider Demographics
NPI:1497921035
Name:ADAMSON, LISA MARY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARY
Last Name:ADAMSON
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 1:955 NE UNION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-4803
Mailing Address - Country:US
Mailing Address - Phone:208-587-6156
Mailing Address - Fax:
Practice Address - Street 1:955 NE UNION ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-4803
Practice Address - Country:US
Practice Address - Phone:208-587-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist