Provider Demographics
NPI:1720183429
Name:FAMIGLIETTI, LISA (MS CCCSLPA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:FAMIGLIETTI
Suffix:
Gender:F
Credentials:MS CCCSLPA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FAMIGLIETTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD
Mailing Address - Street 2:BLDG #2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-327-6179
Mailing Address - Fax:512-327-1545
Practice Address - Street 1:2525 WALLINGWOOD
Practice Address - Street 2:BLDG #2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-327-6179
Practice Address - Fax:512-327-1545
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11398235Z00000X
TX50361231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061352302Medicaid
TX061352302Medicaid