Provider Demographics
NPI:1689710857
Name:EARNHEART, LISA LEE (MA SLPCCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEE
Last Name:EARNHEART
Suffix:
Gender:F
Credentials:MA SLPCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 W BANNISTER DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-8434
Mailing Address - Country:US
Mailing Address - Phone:352-746-9464
Mailing Address - Fax:
Practice Address - Street 1:7647 W GULF TO LAKE HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7962
Practice Address - Country:US
Practice Address - Phone:352-795-4181
Practice Address - Fax:352-795-7981
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888158800Medicaid