Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lisa Jane Fullenkamp, MA, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1104082205

Lisa Jane Fullenkamp, MA, CCC-SLP is a Speech-Language Pathologist in Council Bluffs, Iowa. Licensed in Iowa. Registered with an NPI since 2008.

Licensed in
IA
In the registry since
2008
What do these letters mean?
MA — Master of Arts
A graduate arts degree.
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

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Practice location Address checks out

3000 Risen Son Blvd
Council Bluffs, IA 51503-1911
Phone: (712) 366-0286
Fax: (712) 366-0277
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 01568 (IA)

Record details

NPI number1104082205
Entity typeIndividual (Type 1)
GenderFemale
Credentials MA , CCC-SLP
Sole proprietorNo
NPI enumeratedJuly 29, 2008
Last updated in NPPESJuly 29, 2008

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