Provider Demographics
NPI:1356783971
Name:DUNN, LISA BALDWIN (MCD CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BALDWIN
Last Name:DUNN
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RED BUD TRL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-3117
Mailing Address - Country:US
Mailing Address - Phone:770-253-3318
Mailing Address - Fax:
Practice Address - Street 1:110 EDGEWORTH RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6916
Practice Address - Country:US
Practice Address - Phone:770-683-6984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP04719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist