Provider Demographics
NPI:1720491186
Name:KEDO, LISA JO
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JO
Last Name:KEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CITYGATE DR
Mailing Address - Street 2:EDUCATINAL SERVICE CENTER OF CENTRAL OHIO
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:614-445-3750
Mailing Address - Fax:614-445-3767
Practice Address - Street 1:8715 BIG BEAR AVENUE
Practice Address - Street 2:SCIOTO RIDGE ELEMENTARY SCHOOL
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065
Practice Address - Country:US
Practice Address - Phone:740-657-4800
Practice Address - Fax:740-657-4849
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.5017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist