Healthcare Provider Details

I. General information

NPI: 1700434180
Provider Name (Legal Business Name): LISA ANNE SLOAN MA,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N 54TH ST # 0R
PHILADELPHIA PA
19131-2423
US

IV. Provider business mailing address

2401 N 54TH ST # 0R
PHILADELPHIA PA
19131-2423
US

V. Phone/Fax

Practice location:
  • Phone: 215-879-4023
  • Fax:
Mailing address:
  • Phone: 215-879-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL-005611L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: