Individual
MS. LISA JANE BOOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, ED.S.
Contact information
Practice address
5901 PLANTATION CIR, ROANOKE, VA 24019-4937
(540) 561-8175
Mailing address
5901 PLANTATION CIR, ROANOKE, VA 24019-4937
(540) 561-8175
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0813001187
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0813001187
STATE LICENSE LIMITED
VA
Enumeration date
01/04/2022
Last updated
01/04/2022
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