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General NPI Number Information
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NPI Number | 1790981736
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Entity Type | Individual
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Provider Name | LISA MARIE MACLEOD SLP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | USA MEDDAC BAVARIA CMR 411 BLDG 700
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City | APO
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State | AE
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Zip | 09112
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Country | US
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Telephone | 314-590-2400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | FREEDOM
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State | NH
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Zip | 03836-0037
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Country | US
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Telephone | 603-539-4134
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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 | SP1382
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License Number State | ME
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