Provider Demographics
NPI:1457564262
Name:DEMENT, LISA ANN (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DEMENT
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 HARVESTER DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-7042
Mailing Address - Country:US
Mailing Address - Phone:330-622-5052
Mailing Address - Fax:
Practice Address - Street 1:1150 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7129
Practice Address - Country:US
Practice Address - Phone:330-867-2150
Practice Address - Fax:330-836-2671
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist