Individual
LISA MARIE MELLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
2901 FALK RD, VANCOUVER, WA 98661-6392
(360) 313-3668
Mailing address
4603 N KERBY AVE, PORTLAND, OR 97217-3043
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
60977485
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60977485
WASHINGTON STATE DEPT. OF HEALTH
WA
Enumeration date
10/17/2019
Last updated
10/17/2019
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