1689798852 NPI number — MS. LISA M DEWEY MA,CCC-SLP

Table of content: MS. LISA M DEWEY MA,CCC-SLP (NPI 1689798852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689798852 NPI number — MS. LISA M DEWEY MA,CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWEY
Provider First Name:
LISA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA,CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689798852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 RED CEDAR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28374-6918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-235-3699
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 PARKER LN
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374-7903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-295-3133
Provider Business Practice Location Address Fax Number:
910-295-2723
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3122 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 562033116 . This is a "TRICARE- TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 28436 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3403400 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com