Provider Demographics
NPI:1356307342
Name:BROW, LISA SISNEROS (SP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SISNEROS
Last Name:BROW
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 RICHFIELD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122
Mailing Address - Country:US
Mailing Address - Phone:505-797-1952
Mailing Address - Fax:
Practice Address - Street 1:11306 RICHFIELD NE
Practice Address - Street 2:
Practice Address - City:ALBUQERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122
Practice Address - Country:US
Practice Address - Phone:505-797-1952
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist