MEDICARE: LISA WALDROUP

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	3416	NC

General Provider Information

NPI Number	:	1194669788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WALDROUP

Provider Business Mailing Address
First Line	:	351 COVE TRAIL RD
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-0409
Country	:	US
Telephone Number	:	828-736-0852
Fax Number	:	828-488-8510

Provider Business Practice Location Address
First Line	:	50 MAIN ST
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-1370
Country	:	US
Telephone Number	:	828-488-3129
Fax Number	:	828-488-8510

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ LISA WALDROUP ” Practice Location

Language	Start Address	Practice Location

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