Provider Demographics
NPI:1356594014
Name:JOHNSON, LISA ANNE (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:D'ANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC/SLP
Mailing Address - Street 1:750 HICKSVILLE RD
Mailing Address - Street 2:RD
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783
Mailing Address - Country:US
Mailing Address - Phone:516-520-6057
Mailing Address - Fax:
Practice Address - Street 1:750 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1328
Practice Address - Country:US
Practice Address - Phone:516-520-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist