MEDICARE: LISA FITE SPEECH LANGUAGE PATHOLOGY PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1447193339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA FITE SPEECH LANGUAGE PATHOLOGY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	15218 SUMMIT AVE STE 300-218
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-600-5323
Fax Number	:

Provider Business Practice Location Address
First Line	:	15218 SUMMIT AVE STE 300-218
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-0232
Country	:	US
Telephone Number	:	909-600-5323
Fax Number	:

Authorized Official
Title or Position	:	CEO/CFO/SECRETARY
Name	:	LISA JEAN FITE
Credential	:	M.A. CCC-SLP
Telephone Number	:	909-600-5323

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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