Provider Demographics
NPI:1316146376
Name:HUSSEY, LISA K (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 CLIFTON ST
Mailing Address - Street 2:#5
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2462
Mailing Address - Country:US
Mailing Address - Phone:617-913-0400
Mailing Address - Fax:
Practice Address - Street 1:3 BURLINGTON WOODS
Practice Address - Street 2:SUITE 304
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4514
Practice Address - Country:US
Practice Address - Phone:781-270-0222
Practice Address - Fax:781-270-5005
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist