Provider Demographics
NPI:1104219401
Name:MACRI, LISA (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MACRI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44050 ASHBURN SHOPPING PLZ
Mailing Address - Street 2:#195-141
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7915
Mailing Address - Country:US
Mailing Address - Phone:571-606-8857
Mailing Address - Fax:
Practice Address - Street 1:44050 ASHBURN SHOPPING PLZ
Practice Address - Street 2:#195-141
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7915
Practice Address - Country:US
Practice Address - Phone:571-606-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist