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NPI Code Detail

MEDICARE: MRS. LISA ANN IMAN M.S., CCC-SLP

MEDICARE: MRS. LISA ANN IMAN M.S., CCC-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
1235Z00000XSpeech-Language Pathologist2202006558VA
2235Z00000XSpeech-Language PathologistSLP012723GA
3235Z00000XSpeech-Language Pathologist15004NC

General Provider Information

NPI Number : 1417312141
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA ANN IMAN M.S., CCC-SLP
Provider Business Mailing Address
First Line : 509 CLEARBROOK DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28409-5901
Country : US
Telephone Number : 757-839-2884
Fax Number :
Provider Business Practice Location Address
First Line : 18676 US HIGHWAY 17
Second Line :
City : HAMPSTEAD
State : NC
Zip : 28443-4049
Country : US
Telephone Number : 910-821-1700
Fax Number : 910-319-9105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2015
Last Update Date : 09/04/2024

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Directions to “ MRS. LISA ANN IMAN M.S., CCC-SLP” Practice Location

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