MEDICARE: LAIS SCAPPIN 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	121790	TX
2	235Z00000X	Speech-Language Pathologist	30001112	NC
3	235Z00000X	Speech-Language Pathologist	2779	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2779	OTHER	NE	NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES

General Provider Information

NPI Number	:	1841928603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAIS SCAPPIN CCC-SLP

Provider Business Mailing Address
First Line	:	1219 S LAMAR BLVD APT 521
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2178
Country	:	US
Telephone Number	:	201-966-3915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 S LAMAR BLVD APT 521
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2178
Country	:	US
Telephone Number	:	201-966-3915
Fax Number	:

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

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	09/26/2024

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Directions to “ LAIS SCAPPIN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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