Provider Demographics
NPI:1811008733
Name:MYRICK, LISA A (AUD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:MYRICK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CENTERVILLE RD
Mailing Address - Street 2:SUITE 5400
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4655
Mailing Address - Country:US
Mailing Address - Phone:850-877-0101
Mailing Address - Fax:850-877-2750
Practice Address - Street 1:1405 CENTERVILLE RD
Practice Address - Street 2:SUITE 5400
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4655
Practice Address - Country:US
Practice Address - Phone:850-877-0101
Practice Address - Fax:850-877-2750
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY264231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist