Provider Demographics
NPI:1689798852
Name:DEWEY, LISA M (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:DEWEY
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 1:11 RED CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-6918
Mailing Address - Country:US
Mailing Address - Phone:910-235-3699
Mailing Address - Fax:
Practice Address - Street 1:10 PARKER LN
Practice Address - Street 2:SUITE 1
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7903
Practice Address - Country:US
Practice Address - Phone:910-295-3133
Practice Address - Fax:910-295-2723
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562033116OtherTRICARE- TAX ID
NC28436OtherBCBS
NC3403400Medicaid