MEDICARE: MRS. LISA LOUISE UPPERMAN SLPA

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	2355S0801X	Speech-Language Assistant	8049	AZ

General Provider Information

NPI Number	:	1952654402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA LOUISE UPPERMAN SLPA

Provider Business Mailing Address
First Line	:	5310 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2805
Country	:	US
Telephone Number	:	602-803-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2805
Country	:	US
Telephone Number	:	602-803-7600
Fax Number	:

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

Provider Enumeration Date	:	10/22/2012
Last Update Date	:	10/22/2012

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