Individual
LISA WILLMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC
Contact information
Practice address
1170 FOLLY RD, CHARLESTON, SC 29412-4114
(843) 754-6422
(877) 889-2029
Mailing address
1139 SHOREHAM RD, CHARLESTON, SC 29412-9364
(843) 754-6422
(843) 216-2445
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4701
SC
Other
Enumeration date
07/22/2010
Last updated
10/03/2024
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