Provider Demographics
NPI:1003091885
Name:SCAVEZZE, LISA A (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SCAVEZZE
Suffix:
Gender:F
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 1:8880 E 105TH CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7061
Mailing Address - Country:US
Mailing Address - Phone:918-369-8883
Mailing Address - Fax:
Practice Address - Street 1:8880 E 105TH CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7061
Practice Address - Country:US
Practice Address - Phone:918-369-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist