Provider Demographics
NPI:1023346848
Name:PISA, LISA GUERRA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GUERRA
Last Name:PISA
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:1789 DRIFTWOOD POINT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3032
Mailing Address - Country:US
Mailing Address - Phone:504-421-1446
Mailing Address - Fax:
Practice Address - Street 1:1789 DRIFTWOOD POINT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3032
Practice Address - Country:US
Practice Address - Phone:504-421-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2046235Z00000X
FL16959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist