Provider Demographics
NPI:1558643528
Name:OSBORNE, LISA CARROLL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CARROLL
Last Name:OSBORNE
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:P.O. BOX 1288
Mailing Address - Street 2:580 FARRINGDOM STREET
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359
Mailing Address - Country:US
Mailing Address - Phone:910-671-9629
Mailing Address - Fax:910-671-9630
Practice Address - Street 1:1271 BEAUFORT RD
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-7869
Practice Address - Country:US
Practice Address - Phone:910-470-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist