MEDICARE: MRS. LISA MICHELE LETOURNEAU M.S., SLP-TSSLD

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	016145	NY

General Provider Information

NPI Number	:	1235274903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MICHELE LETOURNEAU M.S., SLP-TSSLD

Provider Business Mailing Address
First Line	:	2748 MAPLE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-2438
Country	:	US
Telephone Number	:	516-225-6781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2748 MAPLE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-2438
Country	:	US
Telephone Number	:	516-225-6781
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	02/26/2016

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