Provider Demographics
NPI:1558503920
Name:LIEBERMAN, LISA J (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 YELLOW PINE CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-4041
Mailing Address - Country:US
Mailing Address - Phone:614-746-5737
Mailing Address - Fax:
Practice Address - Street 1:9040 YELLOW PINE CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-4041
Practice Address - Country:US
Practice Address - Phone:614-746-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9330235Z00000X
GA009241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist