Provider Demographics
NPI:1639769763
Name:METSOPOLOS, LISA ANNE (SLPA, RBT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:METSOPOLOS
Suffix:
Gender:F
Credentials:SLPA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 W FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1600
Mailing Address - Country:US
Mailing Address - Phone:602-570-2749
Mailing Address - Fax:
Practice Address - Street 1:1526 W GLENDALE AVE STE 109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8576
Practice Address - Country:US
Practice Address - Phone:602-625-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ127882355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant