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NPI Code Detail

MEDICARE: MRS. LISA MARIE AZZOLINA MS CCC-SLP

MEDICARE: MRS. LISA MARIE AZZOLINA 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
1235Z00000XSpeech-Language Pathologist41YS003609NJ

General Provider Information

NPI Number : 1467675603
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA MARIE AZZOLINA MS CCC-SLP
Provider Business Mailing Address
First Line : 11 MARY ANN DR
Second Line :
City : BRICK
State : NJ
Zip : 08723-5817
Country : US
Telephone Number : 908-307-3547
Fax Number : 732-295-3246
Provider Business Practice Location Address
First Line : 1515 HULSE RD
Second Line :
City : POINT PLEASANT BORO
State : NJ
Zip : 08742-4527
Country : US
Telephone Number : 732-295-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. LISA MARIE AZZOLINA MS CCC-SLP” Practice Location

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