Provider Demographics
NPI:1578294617
Name:STEVENS, LISA KAY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 15TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3578
Mailing Address - Country:US
Mailing Address - Phone:727-409-3816
Mailing Address - Fax:
Practice Address - Street 1:6187 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4340
Practice Address - Country:US
Practice Address - Phone:305-650-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16684235Z00000X
TN7905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist