Healthcare Provider Details

I. General information

NPI: 1578640173
Provider Name (Legal Business Name): LISA ROWE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WASHINGTON ST SUITE 200
VALPARAISO IN
46383-4714
US

IV. Provider business mailing address

PO BOX 1425
VALPARAISO IN
46384-1425
US

V. Phone/Fax

Practice location:
  • Phone: 219-741-9242
  • Fax: 219-477-4171
Mailing address:
  • Phone: 219-741-9242
  • Fax: 219-477-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004121A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: