Provider Demographics
NPI:1649694803
Name:WAALAND, LISA DIANE (BS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:WAALAND
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 QUAIL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7183
Mailing Address - Country:US
Mailing Address - Phone:419-348-0617
Mailing Address - Fax:
Practice Address - Street 1:600 W YATES AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1160
Practice Address - Country:US
Practice Address - Phone:419-425-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist