Provider Demographics
NPI:1619424272
Name:TIBBETTS-OSSO, LISA (M ED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TIBBETTS-OSSO
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11413 CHANCELLOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8419
Mailing Address - Country:US
Mailing Address - Phone:540-429-6323
Mailing Address - Fax:540-786-0625
Practice Address - Street 1:11413 CHANCELLOR PARK DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8419
Practice Address - Country:US
Practice Address - Phone:540-429-6323
Practice Address - Fax:540-786-0625
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist