Individual
LISA LOVERN GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.,CCC-SLP
Contact information
Practice address
545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Mailing address
545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003963
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000745269A
—
GA
05
—
10035695
—
GA
05
—
305502
—
GA
01
—
52661318-002
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/28/2006
Last updated
08/17/2011
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