Provider Demographics
NPI:1740670074
Name:HACOBIAN, LISA AYVAZIAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:AYVAZIAN
Last Name:HACOBIAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 E VERDUGO AVE
Mailing Address - Street 2:UNIT J
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2365
Mailing Address - Country:US
Mailing Address - Phone:818-618-6964
Mailing Address - Fax:818-558-1385
Practice Address - Street 1:557 E VERDUGO AVE
Practice Address - Street 2:UNIT J
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2365
Practice Address - Country:US
Practice Address - Phone:818-618-6964
Practice Address - Fax:818-558-1385
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist