Provider Demographics
NPI:1922399708
Name:SPIEGEL, LISA (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WAYMONT CT
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3412
Mailing Address - Country:US
Mailing Address - Phone:407-323-0399
Mailing Address - Fax:407-323-0286
Practice Address - Street 1:100 WAYMONT CT
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3412
Practice Address - Country:US
Practice Address - Phone:407-323-0399
Practice Address - Fax:407-323-0286
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY714231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist