Provider Demographics
NPI:1851652283
Name:MC INTIRE, LISA MAUREEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MAUREEN
Last Name:MC INTIRE
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 1:55 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1847
Mailing Address - Country:US
Mailing Address - Phone:626-355-1729
Mailing Address - Fax:626-836-6927
Practice Address - Street 1:55 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-1847
Practice Address - Country:US
Practice Address - Phone:626-355-1729
Practice Address - Fax:626-836-6927
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist