Provider Demographics
NPI:1700912847
Name:SQUADRITO, LISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SQUADRITO
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 1:17122 LYNN LN APT C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTN BCH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4347
Mailing Address - Country:US
Mailing Address - Phone:206-940-7013
Mailing Address - Fax:
Practice Address - Street 1:17122 LYNN LN APT C
Practice Address - Street 2:
Practice Address - City:HUNTINGTN BCH
Practice Address - State:CA
Practice Address - Zip Code:92649-4347
Practice Address - Country:US
Practice Address - Phone:206-940-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003737235Z00000X
CA21638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist