Provider Demographics
NPI:1801942883
Name:BREAKEY, LISA (MA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BREAKEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S BASCOM AVE
Mailing Address - Street 2:SUITE 1113
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3536
Mailing Address - Country:US
Mailing Address - Phone:408-297-9740
Mailing Address - Fax:650-462-0960
Practice Address - Street 1:950 S BASCOM AVE
Practice Address - Street 2:SUITE 1113
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3536
Practice Address - Country:US
Practice Address - Phone:408-297-9740
Practice Address - Fax:650-462-0960
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist