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NPI Code Detail

MEDICARE: LISA WALSER PRIDGEN M.ED., CCC/SLP

MEDICARE: LISA WALSER PRIDGEN M.ED., 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 Pathologist9904NC

General Provider Information

NPI Number : 1750717260
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA WALSER PRIDGEN M.ED., CCC/SLP
Provider Business Mailing Address
First Line : 616 DR CALVIN JONES HWY STE 212
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3106
Country : US
Telephone Number : 919-219-5277
Fax Number :
Provider Business Practice Location Address
First Line : 616 DR CALVIN JONES HWY STE 212
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3106
Country : US
Telephone Number : 919-219-5277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2013
Last Update Date : 01/17/2025

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Directions to “ LISA WALSER PRIDGEN M.ED., CCC/SLP” Practice Location

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