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NPI Code Detail

MEDICARE: MRS. LISA MARIE VITAZ ST

MEDICARE: MRS. LISA MARIE VITAZ ST
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 PathologistSP8028OH

General Provider Information

NPI Number : 1508990243
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA MARIE VITAZ ST
Provider Business Mailing Address
First Line : 6389 STANBURY RD
Second Line :
City : PARMA
State : OH
Zip : 44129-5042
Country : US
Telephone Number : 440-845-4312
Fax Number :
Provider Business Practice Location Address
First Line : 6455 PEARL RD
Second Line :
City : PARMA HEIGHTS
State : OH
Zip : 44130-2984
Country : US
Telephone Number : 440-887-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. LISA MARIE VITAZ ST” Practice Location

Language Start Address Practice Location
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