Provider Demographics
NPI:1942358346
Name:PHILLIPS, LISA (MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4559
Mailing Address - Country:US
Mailing Address - Phone:401-465-3004
Mailing Address - Fax:
Practice Address - Street 1:1048 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4559
Practice Address - Country:US
Practice Address - Phone:401-465-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist