Provider Demographics
NPI:1700434180
Name:SLOAN, LISA ANNE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:SLOAN
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 1:2401 N 54TH ST # 0R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2423
Mailing Address - Country:US
Mailing Address - Phone:215-879-4023
Mailing Address - Fax:
Practice Address - Street 1:2401 N 54TH ST # 0R
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2423
Practice Address - Country:US
Practice Address - Phone:215-879-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-005611L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist