Provider Demographics
NPI:1033342795
Name:MESSINA, LISA ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MESSINA
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 1:33 WINDING PATH
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2276
Mailing Address - Country:US
Mailing Address - Phone:631-909-1733
Mailing Address - Fax:
Practice Address - Street 1:341 AVENUE B
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-1942
Practice Address - Country:US
Practice Address - Phone:631-909-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016296235Z00000X
FL19532235Z00000X
NY0162961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist