Healthcare Provider Details

I. General information

NPI: 1386715829
Provider Name (Legal Business Name): LISA THOMPSON WELLS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 LEXINGTON RD
WILMORE KY
40390-9774
US

IV. Provider business mailing address

1575 LEXINGTON RD
WILMORE KY
40390-9774
US

V. Phone/Fax

Practice location:
  • Phone: 859-858-9197
  • Fax: 859-858-2733
Mailing address:
  • Phone: 859-858-9197
  • Fax: 859-858-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1582
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: