Provider Demographics
NPI:1619116837
Name:PRICE, LISA D (MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:PRICE
Suffix:
Gender:F
Credentials:MS
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 61
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-0061
Mailing Address - Country:US
Mailing Address - Phone:606-310-1239
Mailing Address - Fax:
Practice Address - Street 1:61 COURT HOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-0061
Practice Address - Country:US
Practice Address - Phone:606-376-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist