Provider Demographics
NPI:1083810071
Name:SPEAKS, MONA LISA (PROSTHETIC PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:LISA
Last Name:SPEAKS
Suffix:
Gender:F
Credentials:PROSTHETIC PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 N SAGINAW ST
Mailing Address - Street 2:100
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2165
Mailing Address - Country:US
Mailing Address - Phone:248-338-0723
Mailing Address - Fax:248-338-0817
Practice Address - Street 1:91 N SAGINAW ST
Practice Address - Street 2:100
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2165
Practice Address - Country:US
Practice Address - Phone:248-338-0723
Practice Address - Fax:248-338-0817
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3831245441744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management