Provider Demographics
NPI:1386530756
Name:BALDELLI, LISA (SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BALDELLI
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:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-1129
Mailing Address - Country:US
Mailing Address - Phone:203-217-1836
Mailing Address - Fax:
Practice Address - Street 1:33 BULLET HILL RD STE 301
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4697
Practice Address - Country:US
Practice Address - Phone:203-217-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist