Provider Demographics
NPI:1104973486
Name:BROOKS, LISA M (MA, CCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 FARM RD
Mailing Address - Street 2:STE. 180338
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8170
Mailing Address - Country:US
Mailing Address - Phone:702-884-9945
Mailing Address - Fax:702-396-6237
Practice Address - Street 1:8414 FARM RD
Practice Address - Street 2:STE. 180338
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8170
Practice Address - Country:US
Practice Address - Phone:702-884-9945
Practice Address - Fax:702-396-6237
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500959Medicaid