Provider Demographics
NPI:1831397769
Name:DAYTON, LISA (SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAYTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CLARENDON
Mailing Address - State:VT
Mailing Address - Zip Code:05759-9501
Mailing Address - Country:US
Mailing Address - Phone:802-775-3264
Mailing Address - Fax:
Practice Address - Street 1:2321 MIDDLE RD STE 1
Practice Address - Street 2:
Practice Address - City:NORTH CLARENDON
Practice Address - State:VT
Practice Address - Zip Code:05759-9501
Practice Address - Country:US
Practice Address - Phone:802-775-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017382-1235Z00000X
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist