Provider Demographics
NPI:1023595006
Name:PRESTI, LISA MARY (SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARY
Last Name:PRESTI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4416
Mailing Address - Country:US
Mailing Address - Phone:954-262-7726
Mailing Address - Fax:
Practice Address - Street 1:6100 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4416
Practice Address - Country:US
Practice Address - Phone:954-262-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-6804235Z00000X
GASLP009619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist