Provider Demographics
NPI:1770080822
Name:COMEAU, LISSA MARTIN (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LISSA
Middle Name:MARTIN
Last Name:COMEAU
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 1:8700 CENTREVILLE RD # 400
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8430
Mailing Address - Country:US
Mailing Address - Phone:571-377-6122
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTREVILLE RD # 400
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8430
Practice Address - Country:US
Practice Address - Phone:571-377-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist