Healthcare Provider Details

I. General information

NPI: 1982518700
Provider Name (Legal Business Name): LISA MAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 RINCONADA DR
SANTA ROSA CA
95409-3030
US

IV. Provider business mailing address

4857 CANYON DR
SANTA ROSA CA
95409-3264
US

V. Phone/Fax

Practice location:
  • Phone: 707-542-7375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: