Provider Demographics
NPI:1689128381
Name:DUWELL, LISA ANN (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DUWELL
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 1:56 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-1002
Mailing Address - Country:US
Mailing Address - Phone:513-467-3210
Mailing Address - Fax:
Practice Address - Street 1:56 COOPER AVE
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-1002
Practice Address - Country:US
Practice Address - Phone:513-467-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHIO SP. 3481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist