Provider Demographics
NPI:1790144269
Name:MARRERO MONTES, LISANDRA (MS SLP)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:MARRERO MONTES
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 CALLE DEL PARQUE
Mailing Address - Street 2:APT. 3F
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3703
Mailing Address - Country:US
Mailing Address - Phone:787-629-7535
Mailing Address - Fax:
Practice Address - Street 1:361 CALLE DEL PARQUE
Practice Address - Street 2:APT. 3F
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3703
Practice Address - Country:US
Practice Address - Phone:787-629-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist