Provider Demographics
NPI:1518031178
Name:SWANN, LISA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:SWANN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1215
Mailing Address - Country:US
Mailing Address - Phone:417-466-7726
Mailing Address - Fax:
Practice Address - Street 1:JOPLIN PUBLIC SCHOOLS, JEC
Practice Address - Street 2:2825 S MCCLELLAND BLVD.
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-625-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist