Provider Demographics
NPI:1306836424
Name:CHERBAKA, LISSA (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LISSA
Middle Name:
Last Name:CHERBAKA
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3658
Mailing Address - Country:US
Mailing Address - Phone:703-806-4658
Mailing Address - Fax:703-806-4648
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:ATTN: AUDIOLOGY CLINIC
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-806-4658
Practice Address - Fax:703-806-4648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000652231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist