Healthcare Provider Details

I. General information

NPI: 1659674844
Provider Name (Legal Business Name): LYDIA FAITH VISSER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST FL 5
SAN FRANCISCO CA
94115-3465
US

IV. Provider business mailing address

2330 POST ST FL 5
SAN FRANCISCO CA
94115-3465
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: