Provider Demographics
NPI:1396934899
Name:NEWSTEAD, LISA ANNE-VINE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE-VINE
Last Name:NEWSTEAD
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 1:11060 HI TECH DR
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9133
Mailing Address - Country:US
Mailing Address - Phone:734-449-4649
Mailing Address - Fax:
Practice Address - Street 1:11060 HI TECH DR
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9133
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12026653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist