Provider Demographics
NPI:1639471634
Name:TUZON, LISA SORIANO (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SORIANO
Last Name:TUZON
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 1:5417 WESLEYAN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6922
Mailing Address - Country:US
Mailing Address - Phone:757-490-0736
Mailing Address - Fax:757-499-0230
Practice Address - Street 1:5417 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6922
Practice Address - Country:US
Practice Address - Phone:757-490-0736
Practice Address - Fax:757-499-0230
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist