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General NPI Number Information
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NPI Number | 1669006037
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Entity Type | Individual
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Provider Name | LISA HER WOLFMAN CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 1680 E ROSEVILLE PKWY STE 112
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City | ROSEVILLE
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State | CA
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Zip | 95661-3988
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Country | US
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Telephone | 916-784-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 BRINGHURST LN
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City | DAVIS
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State | CA
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Zip | 95616-1370
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Country | US
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Telephone | 916-708-5141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 26131
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License Number State | CA
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