Provider Demographics
NPI:1922165547
Name:SAMARDICH, LISA CATHRYN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CATHRYN
Last Name:SAMARDICH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CATHRYN
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160694
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-0694
Mailing Address - Country:US
Mailing Address - Phone:406-209-3583
Mailing Address - Fax:
Practice Address - Street 1:720 STONERIDGE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7032
Practice Address - Country:US
Practice Address - Phone:406-556-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist