Provider Demographics
NPI:1417149758
Name:REUTHER, LISA DUFFY (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DUFFY
Last Name:REUTHER
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 VALENCIA LN
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2364
Mailing Address - Country:US
Mailing Address - Phone:863-248-2723
Mailing Address - Fax:
Practice Address - Street 1:346 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3046
Practice Address - Country:US
Practice Address - Phone:863-291-8644
Practice Address - Fax:863-293-3221
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist