MEDICARE: LISA MIODOWSKI M.A., 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	7101005140	MI

General Provider Information

NPI Number	:	1043894397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MIODOWSKI M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	2737 NEW ENGLAND DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2819
Country	:	US
Telephone Number	:	586-873-9967
Fax Number	:

Provider Business Practice Location Address
First Line	:	2737 NEW ENGLAND DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2819
Country	:	US
Telephone Number	:	586-873-9967
Fax Number	:

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

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	11/10/2025

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