Lisa Clayton, ST

Individual provider Active NPI Speech-Language Pathologist · Hettinger, ND

NPI 1922192004 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1922192004
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
759 (ND)
Practice address
1000 Highway 12
Hettinger, ND 58639-7530
Phone
(701) 567-6045
Fax
(701) 567-6361
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
759NDMDPhysical Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 759 ND Yes

Addresses

Primary practice location

1000 Highway 12
Hettinger, ND 58639-7530

Mailing address

208 Lakeview Dr
Hettinger, ND 58639-9500
Phone (701) 567-2241

Other identifiers

IdentifierTypeStateIssuer
18864OtherNDBLUE CROSS OF NORTH DAKOT

Other providers in Hettinger, ND

All providers in Hettinger, ND · Speech-Language Pathologist in North Dakota

Sources for this page

Verify at the official NPI Registry.