Provider Demographics
NPI:1225810799
Name:LISAN SPEECH, SWALLOW, & VOICE THERAPY PLLC
Entity Type:Organization
Organization Name:LISAN SPEECH, SWALLOW, & VOICE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSUFUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:630-776-8753
Mailing Address - Street 1:2206 N MAIN ST # 168
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-9140
Mailing Address - Country:US
Mailing Address - Phone:630-776-8753
Mailing Address - Fax:331-299-2366
Practice Address - Street 1:2206 N MAIN ST # 168
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-9140
Practice Address - Country:US
Practice Address - Phone:630-776-8753
Practice Address - Fax:331-299-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty