Provider Demographics
NPI:1316225022
Name:VIRISSIMO, LIZETTE T
Entity Type:Individual
Prefix:MRS
First Name:LIZETTE
Middle Name:T
Last Name:VIRISSIMO
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 1:4848 E ROOSEVELT ST APT 2037
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7335
Mailing Address - Country:US
Mailing Address - Phone:480-241-6442
Mailing Address - Fax:
Practice Address - Street 1:2432 W PEORIA AVE STE 1005
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4727
Practice Address - Country:US
Practice Address - Phone:602-626-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant