Provider Demographics
NPI:1174769087
Name:ESCARAVAGE, LISA MARIE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ESCARAVAGE
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 1:12 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2630
Mailing Address - Country:US
Mailing Address - Phone:845-485-7288
Mailing Address - Fax:
Practice Address - Street 1:12 CROMWELL DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2630
Practice Address - Country:US
Practice Address - Phone:845-485-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007770-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist