Provider Demographics
NPI:1952039513
Name:RISLEY, LISA J (SLPA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:RISLEY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 EDINGER AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3727
Mailing Address - Country:US
Mailing Address - Phone:714-916-0641
Mailing Address - Fax:866-806-1080
Practice Address - Street 1:7812 EDINGER AVE STE 400
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3727
Practice Address - Country:US
Practice Address - Phone:714-916-0641
Practice Address - Fax:866-806-1080
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3489OtherSLPA LICENSE