Provider Demographics
NPI:1003006305
Name:ANDERSON, LISA KAY (CCC/SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC, SLP
Mailing Address - Street 1:1201 E 15TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6238
Mailing Address - Country:US
Mailing Address - Phone:972-424-0148
Mailing Address - Fax:972-422-5275
Practice Address - Street 1:1201 E 15TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6238
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist