Provider Demographics
NPI:1114128683
Name:HARWIN, LISA SANDERS (MA SPL DISORDERS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SANDERS
Last Name:HARWIN
Suffix:
Gender:F
Credentials:MA SPL DISORDERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23241 VENTURA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1048
Mailing Address - Country:US
Mailing Address - Phone:818-224-2025
Mailing Address - Fax:818-224-4306
Practice Address - Street 1:23241 VENTURA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1048
Practice Address - Country:US
Practice Address - Phone:818-224-2025
Practice Address - Fax:818-224-4306
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist