Provider Demographics
NPI:1891944732
Name:POTEET, LISA BRATTON (MS, SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BRATTON
Last Name:POTEET
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2505
Mailing Address - Country:US
Mailing Address - Phone:501-447-3924
Mailing Address - Fax:501-447-3901
Practice Address - Street 1:7915 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2505
Practice Address - Country:US
Practice Address - Phone:501-447-3924
Practice Address - Fax:501-447-3901
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist