Provider Demographics
NPI:1558574590
Name:LISTER, PAUL B (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:LISTER
Suffix:
Gender:M
Credentials:MA, 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:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574-0508
Mailing Address - Country:US
Mailing Address - Phone:603-869-2408
Mailing Address - Fax:603-869-2408
Practice Address - Street 1:48 RIDGE RD.
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:NH
Practice Address - Zip Code:03574-0508
Practice Address - Country:US
Practice Address - Phone:603-869-2408
Practice Address - Fax:603-869-2408
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist