Individual
LISA BYLER DOMINESEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
366 CAPSTONE LN, SPARTANBURG, SC 29301-5367
(864) 680-2459
Mailing address
366 CAPSTONE LN, SPARTANBURG, SC 29301-5367
(864) 680-2459
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3805
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0667
—
SC
Enumeration date
07/14/2006
Last updated
07/09/2007
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