Provider Demographics
NPI:1902943285
Name:HOWELL, LISA SMALLWOOD (MED, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SMALLWOOD
Last Name:HOWELL
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-0244
Mailing Address - Country:US
Mailing Address - Phone:919-361-1090
Mailing Address - Fax:888-354-2009
Practice Address - Street 1:200 MEREDITH DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2287
Practice Address - Country:US
Practice Address - Phone:919-361-1090
Practice Address - Fax:888-354-2009
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412315Medicaid