Individual
MRS. LISA KNIERIM IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC/SLP
Contact information
Practice address
8575 RIXLEW LN, MANASSAS, VA 20109-3701
(703) 257-2941
Mailing address
24476 RIPPLE CT, ALDIE, VA 20105-5503
(904) 703-9310
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202006805
VA
Other
Enumeration date
11/15/2012
Last updated
03/21/2013
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