Provider Demographics
NPI:1184189730
Name:LISA, BRYNN
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:LISA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3503
Mailing Address - Country:US
Mailing Address - Phone:845-897-3330
Mailing Address - Fax:845-897-3330
Practice Address - Street 1:1032 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3503
Practice Address - Country:US
Practice Address - Phone:845-897-3330
Practice Address - Fax:845-897-3330
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY026850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist