Provider Demographics
NPI:1902041189
Name:PHILLIPS-SPRINGER, LISA A (MS CCC/LSP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:PHILLIPS-SPRINGER
Suffix:
Gender:F
Credentials:MS CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2037
Mailing Address - Country:US
Mailing Address - Phone:631-862-7125
Mailing Address - Fax:
Practice Address - Street 1:235 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2037
Practice Address - Country:US
Practice Address - Phone:631-862-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005001-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist