Lisa Christine Kettleson, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL60040767 Issued in WA

Practice address

200 N Bernard St
Spokane, WA 99201-0206

Phone

(509) 795-1725

NPI assigned

Jan 5, 2021

Last updated

Jan 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Lisa Christine Pogue Former name

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": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1700474798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4203 S HATCH ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992036245",
            "telephone_number": "425-681-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N BERNARD ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992010206",
            "telephone_number": "509-795-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLESON",
        "first_name": "LISA",
        "middle_name": "CHRISTINE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60040767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "POGUE",
            "middle_name": "CHRISTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tommie Lynn Kessler, BA
• Michael F. Kestell, M.D.
• Mitchell Edward Keszler, CRNA
• Ketamine Clinic of Spokane LLC
• Emily Ketchel, PMHNP
• Kevin King, DDS
• Kevin Truong, DMD PLLC
• Bryan David Key, BPHARM
• Ted William Keyes, M.D.
• William David Keyes, MD

• Speech-Language Pathologist in Spokane, WA
• Providers in Spokane, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.