MEDICARE: LISA HESS MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SZ 7046	FL
2	235Z00000X	Speech-Language Pathologist	SA14544	FL

General Provider Information

NPI Number	:	1033502646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HESS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	16807 SHERINGHAM LN
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-6837
Country	:	US
Telephone Number	:	813-390-8143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 W GANDY BLVD STE 12
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3328
Country	:	US
Telephone Number	:	813-728-6601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2015
Last Update Date	:	02/07/2019

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Directions to “ LISA HESS MS, CCC-SLP” Practice Location

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