Provider Demographics
NPI:1104954791
Name:STEVENS, LISA H (SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:STEVENS
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:RR 2 BOX 144-A
Mailing Address - Street 2:COUNTY ROAD 24
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-9640
Mailing Address - Country:US
Mailing Address - Phone:870-798-3179
Mailing Address - Fax:
Practice Address - Street 1:400 MAUL ROAD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701
Practice Address - Country:US
Practice Address - Phone:870-836-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist