Provider Demographics
NPI:1982730123
Name:LAGNENA, LISA DOROTHY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DOROTHY
Last Name:LAGNENA
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 1:107 JOSICA LN
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-5060
Mailing Address - Country:US
Mailing Address - Phone:631-779-3295
Mailing Address - Fax:
Practice Address - Street 1:107 JOSICA LN
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-5060
Practice Address - Country:US
Practice Address - Phone:631-779-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist