Provider Demographics
NPI:1346482502
Name:BURRUSS, LISA H (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:BURRUSS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S GREENWOOD ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-6800
Mailing Address - Country:US
Mailing Address - Phone:615-453-2584
Mailing Address - Fax:
Practice Address - Street 1:107 S GREENWOOD ST
Practice Address - Street 2:SUITE F
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-6800
Practice Address - Country:US
Practice Address - Phone:615-453-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN09144654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist