Provider Demographics
NPI:1851818330
Name:MCARDLE, LISA WILLIAMSON
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WILLIAMSON
Last Name:MCARDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 FOREST LAWN DR
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-1716
Mailing Address - Country:US
Mailing Address - Phone:540-297-9111
Mailing Address - Fax:
Practice Address - Street 1:1100 CELEBRATION AVE STE 210
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-6603
Practice Address - Country:US
Practice Address - Phone:540-297-9111
Practice Address - Fax:540-297-9111
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001310237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist