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General NPI Number Information
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NPI Number | 1801089511
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Entity Type | Individual
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Provider Name | LISA J. REYES M.A., C.C.C.-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2007
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Last Update Date | 08/26/2007
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Provider Practice Location Address
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Address Line | 5651 NW 29TH ST # A
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City | MARGATE
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State | FL
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Zip | 33063-1531
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Country | US
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Telephone | 954-984-2701
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Fax |
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Provider Business Mailing Address
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Address Line | 5582 WELLESLEY PARK DR APT 302
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City | BOCA RATON
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State | FL
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Zip | 33433-6759
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Country | US
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Telephone | 786-376-2859
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 8668
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License Number State | FL
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