MEDICARE: MS. LISA A SPELLS CCCL SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP0000001649	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4100212	OTHER	TN	BCBST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083622070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA A SPELLS CCCL SLP

Provider Business Mailing Address
First Line	:	611 NORTH FIFTH ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-5812
Country	:	US
Telephone Number	:	615-226-1265
Fax Number	:	877-235-2914

Provider Business Practice Location Address
First Line	:	611 NORTH FIFTH ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-5812
Country	:	US
Telephone Number	:	615-226-1265
Fax Number	:	877-235-2914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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