Provider Demographics
NPI:1750491718
Name:MINAHAN, LISA M (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:MINAHAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SHASTA DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3091
Mailing Address - Country:US
Mailing Address - Phone:603-548-2188
Mailing Address - Fax:603-434-9440
Practice Address - Street 1:51 SHASTA DR
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3091
Practice Address - Country:US
Practice Address - Phone:603-548-2188
Practice Address - Fax:603-434-9440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0905235Z00000X
MA5764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist