Provider Demographics
NPI:1922391531
Name:SELTZER, LISA (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SELTZER
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 1:11220 72ND DR
Mailing Address - Street 2:APT D41
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5631
Mailing Address - Country:US
Mailing Address - Phone:718-577-3358
Mailing Address - Fax:
Practice Address - Street 1:11220 72ND DR
Practice Address - Street 2:APT D41
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5631
Practice Address - Country:US
Practice Address - Phone:718-577-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014252-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist