Provider Demographics
NPI:1841592490
Name:HELLER, LISA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:HELLER
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 1:19 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9315
Mailing Address - Country:US
Mailing Address - Phone:973-794-4418
Mailing Address - Fax:
Practice Address - Street 1:19 FAWN DR
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9315
Practice Address - Country:US
Practice Address - Phone:973-794-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00432100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist