Provider Demographics
NPI:1801041710
Name:LISA M. PHILLIPS
Entity Type:Organization
Organization Name:LISA M. PHILLIPS
Other - Org Name:PHILLIPS SPEECH AND LANGUAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, SPEECH/LANG. PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:401-465-3004
Mailing Address - Street 1:1048 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4559
Mailing Address - Country:US
Mailing Address - Phone:401-465-3004
Mailing Address - Fax:
Practice Address - Street 1:1048 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4559
Practice Address - Country:US
Practice Address - Phone:401-465-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6140261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech