Individual
LISA LYNNE PETRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. ED. C.C.C.-SLP
Contact information
Practice address
9811 SARATOGA RD, FORT WAYNE, IN 46804-7039
(260) 602-2924
(260) 432-1109
Mailing address
9811 SARATOGA RD, FORT WAYNE, IN 46804-7039
(260) 602-2924
(260) 432-1109
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22002846A
IN
Other
Enumeration date
04/21/2007
Last updated
07/08/2007
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