MEDICARE: LISA GUERRA PISA MED, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2046	LA
2	235Z00000X	Speech-Language Pathologist	16959	FL

General Provider Information

NPI Number	:	1023346848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GUERRA PISA MED, CCC-SLP

Provider Business Mailing Address
First Line	:	1789 DRIFTWOOD POINT RD
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-3032
Country	:	US
Telephone Number	:	504-421-1446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1789 DRIFTWOOD POINT RD
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-3032
Country	:	US
Telephone Number	:	504-421-1446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	10/14/2019

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Directions to “ LISA GUERRA PISA MED, CCC-SLP” Practice Location

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