Provider Demographics
NPI:1881877595
Name:GOLZAR, LISA ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:GOLZAR
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 1:10812 JILLIAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4549
Mailing Address - Country:US
Mailing Address - Phone:708-364-1110
Mailing Address - Fax:
Practice Address - Street 1:12828 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2247
Practice Address - Country:US
Practice Address - Phone:708-361-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist