Individual
MRS. LISA RENEE BANUELOS-MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
601 ROBIN LN, LIVINGSTON, MT 59047-3810
(406) 222-7231
(406) 222-2435
Mailing address
504 S 13TH ST, LIVINGSTON, MT 59047-3727
(406) 222-3541
(406) 823-6287
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1225
MT
Other
Enumeration date
10/22/2009
Last updated
03/11/2014
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