Provider Demographics
NPI:1891014171
Name:EICKEL, LISA MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:EICKEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:6506 LOISDALE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1824
Mailing Address - Country:US
Mailing Address - Phone:703-924-4100
Mailing Address - Fax:703-922-5048
Practice Address - Street 1:6506 LOISDALE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1824
Practice Address - Country:US
Practice Address - Phone:703-924-4100
Practice Address - Fax:703-922-5048
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist