MEDICARE: AMANDA LISMAN MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	314335	CO

General Provider Information

NPI Number	:	1154172971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LISMAN MA CCC-SLP

Provider Business Mailing Address
First Line	:	4150 BALSA CT
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2112
Country	:	US
Telephone Number	:	720-366-8363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 14TH ST SW
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-6675
Country	:	US
Telephone Number	:	970-541-1507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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Directions to “ AMANDA LISMAN MA CCC-SLP” Practice Location

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