Provider Demographics
NPI:1821214461
Name:STEARMAN, LISA RENE (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENE
Last Name:STEARMAN
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-1765
Mailing Address - Country:US
Mailing Address - Phone:479-785-5606
Mailing Address - Fax:479-784-8152
Practice Address - Street 1:815 N 16TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-1765
Practice Address - Country:US
Practice Address - Phone:479-785-5606
Practice Address - Fax:479-784-8152
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR335OtherLICENSE NUMBER