Provider Demographics
NPI:1699742536
Name:UDWIN, LISA ELLEN (MA CCC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELLEN
Last Name:UDWIN
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:HOME
Other - Last Name:UDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:447 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2627
Mailing Address - Country:US
Mailing Address - Phone:760-815-8101
Mailing Address - Fax:
Practice Address - Street 1:700 GARDEN VIEW CT
Practice Address - Street 2:STE 201 A
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-815-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist