Provider Demographics
NPI:1861515702
Name:WARD, LISA ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:WARD
Suffix:
Gender:F
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 1:7 WARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7835
Mailing Address - Country:US
Mailing Address - Phone:843-338-3809
Mailing Address - Fax:
Practice Address - Street 1:7 WARRINGTON PL
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-338-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6565235Z00000X
GASLP010175235Z00000X
FLSA 12253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist