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NPI Code Detail

MEDICARE: LISA L MAYBERRY SLP

MEDICARE: LISA L MAYBERRY 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
1235Z00000XSpeech-Language Pathologist
2235Z00000XSpeech-Language Pathologist146004387IL

General Provider Information

NPI Number : 1144328519
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA L MAYBERRY SLP
Provider Business Mailing Address
First Line : 5722 W NEWPORT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-4341
Country : US
Telephone Number : 773-208-1838
Fax Number :
Provider Business Practice Location Address
First Line : 3709 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-4503
Country : US
Telephone Number : 773-377-5492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/28/2022

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Directions to “ LISA L MAYBERRY SLP” Practice Location

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