Provider Demographics
NPI:1386027555
Name:PAVIA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PAVIA
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 1:1203 TOWN CENTER DR
Mailing Address - Street 2:#208
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5208
Mailing Address - Country:US
Mailing Address - Phone:561-929-5545
Mailing Address - Fax:
Practice Address - Street 1:1203 TOWN CENTER DR
Practice Address - Street 2:#208
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5208
Practice Address - Country:US
Practice Address - Phone:561-929-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP22874235Z00000X
FLSA6831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist