Provider Demographics
NPI:1649915463
Name:BARNES, LISA C (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:BARNES
Suffix:
Gender:F
Credentials:MS, 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 631787
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-1787
Mailing Address - Country:US
Mailing Address - Phone:936-561-5511
Mailing Address - Fax:936-569-2297
Practice Address - Street 1:619 SE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-7208
Practice Address - Country:US
Practice Address - Phone:936-564-5511
Practice Address - Fax:936-569-2297
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty