Doctor Name: | LISA WILLMUTH |
NPI Number: | 1043523806 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC |
License Number: | 4701 |
Business Practice Address: | 1127 Queensborough Blvd Ste 104 Mt Pleasant, SC - 294645431 |
Business Phone Number: | 8432160290 |
Business Fax Number: | 8432162445 |
Mailing Address: | Po Box 1753, MT PLEASANT |
State: | SC |
Postal Code: | 294651753 |
Phone Number: | 8432160290 |
Fax Number: | 8432162445 |
NPI Enumeration Date: | 07/22/2010 |
NPI Last Update Date: | 07/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4701 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |