Provider Demographics
NPI:1245552421
Name:LIS, OLGA (MS CCC-A)
Entity type:Individual
Prefix:MISS
First Name:OLGA
Middle Name:
Last Name:LIS
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5101
Mailing Address - Country:US
Mailing Address - Phone:718-421-2782
Mailing Address - Fax:718-421-2783
Practice Address - Street 1:1263 OCEAN PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5105
Practice Address - Country:US
Practice Address - Phone:718-421-2782
Practice Address - Fax:718-421-2783
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001736231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist