MEDICARE: MS. LISA S BYANK MS 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	06951	MD

General Provider Information

NPI Number	:	1366876617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA S BYANK MS CCC-SLP

Provider Business Mailing Address
First Line	:	3613 GOLDEN EAGLE RD
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-2303
Country	:	US
Telephone Number	:	410-274-6091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3613 GOLDEN EAGLE RD
Second Line	:
City	:	PHOENIX
State	:	MD
Zip	:	21131-2303
Country	:	US
Telephone Number	:	410-274-6091
Fax Number	:

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

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	03/31/2025

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