Healthcare Provider Details

I. General information

NPI: 1851060487
Provider Name (Legal Business Name): LISANNE TAYLOR M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 CORPUS CHRISTI DR
AUSTIN TX
78729-7508
US

IV. Provider business mailing address

3803 SPYGLASS CV
ROUND ROCK TX
78664-3956
US

V. Phone/Fax

Practice location:
  • Phone: 512-428-2200
  • Fax: 512-428-2299
Mailing address:
  • Phone: 151-266-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: