Provider Demographics
NPI:1255646683
Name:WILLIAMS, LISA JOAN (MA,CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:JOAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ARNOLD MALL
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2223
Mailing Address - Country:US
Mailing Address - Phone:636-282-0056
Mailing Address - Fax:
Practice Address - Street 1:4 ARNOLD MALL
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2223
Practice Address - Country:US
Practice Address - Phone:636-282-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105176OtherMISSOURI LICENSE NO.