MEDICARE: LISA T SUIRE III

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	2202	LA

General Provider Information

NPI Number	:	1457433716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA T SUIRE III

Provider Business Mailing Address
First Line	:	30644 JOHN DR
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-2125
Country	:	US
Telephone Number	:	225-664-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	768 CHEVELLE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6503
Country	:	US
Telephone Number	:	225-930-0208
Fax Number	:	225-930-0221

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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Directions to “ LISA T SUIRE III ” Practice Location

Language	Start Address	Practice Location

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