MEDICARE: LISA MARIE PEREZ 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	SLP5876	NM

General Provider Information

NPI Number	:	1497439962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE PEREZ MS-CCC-SLP

Provider Business Mailing Address
First Line	:	1030 BUENA VISTA DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-5120
Country	:	US
Telephone Number	:	505-417-3782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 BUENA VISTA DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-5120
Country	:	US
Telephone Number	:	505-417-3782
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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