Provider Demographics
NPI:1851060487
Name:TAYLOR, LISANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISANNE
Middle Name:
Last Name:TAYLOR
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 1:3803 SPYGLASS CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3956
Mailing Address - Country:US
Mailing Address - Phone:151-266-0194
Mailing Address - Fax:
Practice Address - Street 1:6720 CORPUS CHRISTI DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7508
Practice Address - Country:US
Practice Address - Phone:512-428-2200
Practice Address - Fax:512-428-2299
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101135OtherLICENSE FOR SPEECH-LANGUAGE PATHOLOGY
12040593OtherASHA CERTIFICATE OF CLINICAL COMPETENCY