Provider Demographics
NPI:1023465341
Name:LANGWEIL, LISA BETH (MS,CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BETH
Last Name:LANGWEIL
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 1:70 WATERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3522
Mailing Address - Country:US
Mailing Address - Phone:860-604-8119
Mailing Address - Fax:
Practice Address - Street 1:41 N MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1929
Practice Address - Country:US
Practice Address - Phone:860-604-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist