Provider Demographics
NPI:1487870739
Name:JIANNETTO, LISA (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:JIANNETTO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 NEW DORP LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2324
Mailing Address - Country:US
Mailing Address - Phone:718-351-6604
Mailing Address - Fax:718-351-2987
Practice Address - Street 1:91 NEW DORP LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2324
Practice Address - Country:US
Practice Address - Phone:718-351-6604
Practice Address - Fax:718-351-2987
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011622-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist