Individual
LISA WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC/SLP
Contact information
Practice address
650 N JEFFERSON ST, ROANOKE, VA 24016-1427
(540) 904-6718
Mailing address
2174 STONE MILL DR, SALEM, VA 24153-4667
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202002558
VA
Other
Enumeration date
11/03/2010
Last updated
11/03/2010
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