Provider Demographics
NPI:1184834152
Name:GERMANA, LISA (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GERMANA
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 1:6710 GAINES MILL DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3236
Mailing Address - Country:US
Mailing Address - Phone:419-410-3328
Mailing Address - Fax:419-474-5165
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:STE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-474-3399
Practice Address - Fax:419-474-5165
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208864Medicaid
OH366706Medicare ID - Type Unspecified