Provider Demographics
NPI:1336376003
Name:YEUNG, LISA (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:YEUNG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 67TH RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2653
Mailing Address - Country:US
Mailing Address - Phone:718-316-0740
Mailing Address - Fax:
Practice Address - Street 1:10225 67TH RD APT 2A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2653
Practice Address - Country:US
Practice Address - Phone:718-316-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018356-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist