Provider Demographics
NPI:1992901748
Name:MCDERMEIT, LISA A (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MCDERMEIT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 ANAHEIM AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1878
Mailing Address - Country:US
Mailing Address - Phone:505-917-0867
Mailing Address - Fax:505-247-2482
Practice Address - Street 1:5924 ANAHEIM AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1878
Practice Address - Country:US
Practice Address - Phone:505-917-0867
Practice Address - Fax:505-247-2482
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist