Healthcare Provider Details

I. General information

NPI: 1861776296
Provider Name (Legal Business Name): LISA LEE ZIGMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 RAKOWITZ RD
ADKINS TX
78101-9459
US

IV. Provider business mailing address

2791 RAKOWITZ RD
ADKINS TX
78101-9459
US

V. Phone/Fax

Practice location:
  • Phone: 210-213-8813
  • Fax:
Mailing address:
  • Phone: 210-213-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104460
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: