Provider Demographics
NPI:1427592211
Name:LISCHAK, JAMIE ANN (MA CCC-SLP/TSSLD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:LISCHAK
Suffix:
Gender:F
Credentials:MA CCC-SLP/TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 HARRIAD DR S
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1204
Mailing Address - Country:US
Mailing Address - Phone:516-225-0375
Mailing Address - Fax:
Practice Address - Street 1:3662 HARRIAD DR S
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1204
Practice Address - Country:US
Practice Address - Phone:516-225-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026252-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist