MEDICARE: LISANNE FLEMING

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

General Provider Information

NPI Number	:	1508682733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISANNE FLEMING

Provider Business Mailing Address
First Line	:	300 PRIVATE ROAD 33082
Second Line	:
City	:	SUMNER
State	:	TX
Zip	:	75486-5516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E GARNER ST
Second Line	:
City	:	DETROIT
State	:	TX
Zip	:	75436-1944
Country	:	US
Telephone Number	:	903-674-2244
Fax Number	:

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

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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Directions to “ LISANNE FLEMING ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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