Provider Demographics
NPI:1730351107
Name:STILTNER, LISA MORRIS (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MORRIS
Last Name:STILTNER
Suffix:
Gender:
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 WT WHITEHEAD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8409
Mailing Address - Country:US
Mailing Address - Phone:304-890-7071
Mailing Address - Fax:
Practice Address - Street 1:2002 WT WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-8409
Practice Address - Country:US
Practice Address - Phone:304-890-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0988235Z00000X
NC30002945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV740156000Medicaid