Provider Demographics
NPI:1699026500
Name:SCHOPF, LISA BETH (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BETH
Last Name:SCHOPF
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LINDSEY LN STE A
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6902
Mailing Address - Country:US
Mailing Address - Phone:912-729-2294
Mailing Address - Fax:912-673-9457
Practice Address - Street 1:69 LINDSEY LN
Practice Address - Street 2:STE. A
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6901
Practice Address - Country:US
Practice Address - Phone:912-729-2294
Practice Address - Fax:912-673-9457
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008003235Z00000X
FLSA9175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist