Healthcare Provider Details

I. General information

NPI: 1134304199
Provider Name (Legal Business Name): LISA WHITEHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 EAST CATHERINE ST.
ANN ARBOR MI
48109
US

IV. Provider business mailing address

1111 EAST CATHERINE ST.
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-8440
  • Fax:
Mailing address:
  • Phone: 734-764-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: