Provider Demographics
NPI:1184051740
Name:GARRETT, LISA R (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:GARRETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 BLUE STEM CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-0077
Mailing Address - Country:US
Mailing Address - Phone:757-434-8513
Mailing Address - Fax:
Practice Address - Street 1:3616 BLUE STEM CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-0077
Practice Address - Country:US
Practice Address - Phone:757-434-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist