Provider Demographics
NPI:1578640173
Name:ROWE, LISA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials: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 1425
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1425
Mailing Address - Country:US
Mailing Address - Phone:219-741-9242
Mailing Address - Fax:219-477-4171
Practice Address - Street 1:5 WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4714
Practice Address - Country:US
Practice Address - Phone:219-741-9242
Practice Address - Fax:219-477-4171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004121A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000353015OtherANTHEM PIN #