Provider Demographics
NPI:1720233646
Name:RAMOS, LISA NICHOLE (MS-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:NICHOLE
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17222 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3950
Mailing Address - Country:US
Mailing Address - Phone:718-736-3272
Mailing Address - Fax:
Practice Address - Street 1:17222 133RD AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3950
Practice Address - Country:US
Practice Address - Phone:718-736-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016956-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist