Provider Demographics
NPI:1639824097
Name:KLEIN, LISA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
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 1:1788 E COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48819-9746
Mailing Address - Country:US
Mailing Address - Phone:517-983-9083
Mailing Address - Fax:
Practice Address - Street 1:1788 E COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48819-9746
Practice Address - Country:US
Practice Address - Phone:517-983-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist