MEDICARE: LISETTE CASSETTARI M.S., 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	SA15269	FL

General Provider Information

NPI Number	:	1770060758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISETTE CASSETTARI M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	921 PASEO PALMERA
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2057
Country	:	US
Telephone Number	:	561-779-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 NORTHLAKE BLVD STE 203
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1711
Country	:	US
Telephone Number	:	561-842-8996
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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Directions to “ LISETTE CASSETTARI M.S., CCC-SLP” Practice Location

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