Provider Demographics
NPI:1417095068
Name:GULBRANSON, LISA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:GULBRANSON
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1903
Mailing Address - Country:US
Mailing Address - Phone:864-630-1902
Mailing Address - Fax:
Practice Address - Street 1:7432 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1903
Practice Address - Country:US
Practice Address - Phone:864-630-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist