Provider Demographics
NPI:1891972550
Name:HAMBLIN, LISA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E SUNSET WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3474
Mailing Address - Country:US
Mailing Address - Phone:425-557-6657
Mailing Address - Fax:425-557-4409
Practice Address - Street 1:340 E SUNSET WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3474
Practice Address - Country:US
Practice Address - Phone:425-557-6657
Practice Address - Fax:425-557-4409
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist