Provider Demographics
NPI:1013039445
Name:CARDENAS, LISA M (MA/CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MA/CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ALLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-5222
Mailing Address - Country:US
Mailing Address - Phone:630-788-2897
Mailing Address - Fax:
Practice Address - Street 1:103 ALLINGTON CT
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-5222
Practice Address - Country:US
Practice Address - Phone:630-788-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist