Provider Demographics
NPI:1649616061
Name:PINNELL, LISA NICOLE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NICOLE
Last Name:PINNELL
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15190 LEICESTERSHIRE STREET
Mailing Address - Street 2:#221
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6544
Mailing Address - Country:US
Mailing Address - Phone:618-567-4960
Mailing Address - Fax:
Practice Address - Street 1:3940 PRINCE WILLIAM PKWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4513
Practice Address - Country:US
Practice Address - Phone:703-680-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist