Provider Demographics
NPI:1326331877
Name:MOREASUN, LISA MICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELLE
Last Name:MOREASUN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:10310 MACKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3009
Mailing Address - Country:US
Mailing Address - Phone:313-931-2592
Mailing Address - Fax:313-931-2592
Practice Address - Street 1:10310 MACKENZIE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-3009
Practice Address - Country:US
Practice Address - Phone:313-931-2592
Practice Address - Fax:313-931-2592
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist