Healthcare Provider Details

I. General information

NPI: 1477460137
Provider Name (Legal Business Name): LISA K BLAND MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33122 VALLE RD
SAN JUAN CAPISTRANO CA
92675-4853
US

IV. Provider business mailing address

2544 CALLE JADE
SAN CLEMENTE CA
92673-3905
US

V. Phone/Fax

Practice location:
  • Phone: 949-234-9200
  • Fax:
Mailing address:
  • Phone: 949-395-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: