Lisa Marlene Marty, MS CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6288 Issued in MN

Practice address

2144 County Rd 12 South
Buffalo, MN 55313

Phone

(763) 458-4315

Fax

(763) 542-2280

NPI assigned

Apr 11, 2008

Last updated

Apr 11, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1619140456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2144 COUNTY ROAD 12 SOUTH",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "55313",
            "telephone_number": "763-458-4315",
            "fax_number": "763-542-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 COUNTY RD 12 SOUTH",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "55313",
            "telephone_number": "763-458-4315",
            "fax_number": "763-542-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTY",
        "first_name": "LISA",
        "middle_name": "MARLENE",
        "name_prefix": "Mrs.",
        "credential": "MS CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "6288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "V411933831110351",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00072LI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "4600226",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Mae Mahlstedt, LPN
• Mangas Family Chiropractic PLLC
• Corey L Martin, MD
• Joan Marie Martin
• Marty Chiropractic Healing Center, P.a. (InMotion Chiropractic)
• Mary Marty, LP
• Mathisen Optometry,LLC
• Ronald Robin Mathisen, OD
• Mary G Mattison-Wynn, PSY D LP
• Karen H Mattson, R PH

• Speech-Language Pathologist in Buffalo, MN
• Providers in Buffalo, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.