Active NPI
Lisa Anne Ford, SLP
- Speech-Language Pathologist
- Fort Wayne, IN
National Provider Identifier
1881975928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22004887A
- Practice address
- 2118 Inwood Dr
Suite 102
Fort Wayne, IN 46815-7101 - Phone
- (260) 483-9081
- Fax
- (260) 483-9196
- NPI assigned
- Sep 2, 2011
- Last updated
- Sep 2, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 22004887A | IN | Primary |
Addresses
Primary practice location
2118 Inwood Dr
Suite 102
Fort Wayne, IN 46815-7101
Mailing address
2118 Inwood Dr
Suite 102
Fort Wayne, IN 46815-7101
Phone (260) 483-9081
Other names 1
- Lisa Anne Brege
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22004887A | IN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Extended Care Specialists, Inc | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Adult Medicine Physician
- Merrillville, IN
- NPI 1134146079
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314921600000",
"number": "1881975928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2118 INWOOD DR",
"address_2": "SUITE 102",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468157101",
"telephone_number": "260-483-9081",
"fax_number": "260-483-9196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2118 INWOOD DR",
"address_2": "SUITE 102",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468157101",
"telephone_number": "260-483-9081",
"fax_number": "260-483-9196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORD",
"first_name": "LISA",
"middle_name": "ANNE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-02",
"last_updated": "2011-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22004887A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "BREGE",
"middle_name": "ANNE",
"credential": "SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.