Provider Demographics
NPI:1992014286
Name:MCKINNEY, LISA RENE (SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 OLD KINGS RD
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-5427
Mailing Address - Country:US
Mailing Address - Phone:845-706-0440
Mailing Address - Fax:
Practice Address - Street 1:744 GLASCO TURNPIKE
Practice Address - Street 2:
Practice Address - City:MT. MARION
Practice Address - State:NY
Practice Address - Zip Code:12516
Practice Address - Country:US
Practice Address - Phone:845-247-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist