Provider Demographics
NPI:1649406471
Name:WRIGHT, LISA HAWKINS (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:HAWKINS
Last Name:WRIGHT
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 1:2000 DERBY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8025
Mailing Address - Country:US
Mailing Address - Phone:863-686-2421
Mailing Address - Fax:863-686-2421
Practice Address - Street 1:2000 DERBY GLEN DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8025
Practice Address - Country:US
Practice Address - Phone:863-686-2421
Practice Address - Fax:863-686-2421
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9442222Q00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist