Individual provider Active NPI

Lisa Elizabeth Panzarella, MHS, SLP

  • Speech-Language Pathologist
  • St Charles, IL
National Provider Identifier
1174803464
Registry record updated Aug 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
242.001800 Issued in IL
Practice address
40W310 Lafox Rd
St Charles, IL 60175-6588
Phone
(630) 444-0077
Fax
(630) 444-0078
NPI assigned
Aug 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 242.001800 IL Primary

Addresses

Primary practice location

40W310 Lafox Rd
St Charles, IL 60175-6588

Mailing address

40W310 Lafox Rd
St Charles, IL 60175-6588
Phone (630) 444-0077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
242.001800ILMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313625600000",
    "number": "1174803464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40W310 LAFOX RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601756588",
            "telephone_number": "630-444-0077",
            "fax_number": "630-444-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40W310 LAFOX RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601756588",
            "telephone_number": "630-444-0077",
            "fax_number": "630-444-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANZARELLA",
        "first_name": "LISA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Miss",
        "credential": "MHS, SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-18",
        "last_updated": "2011-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.001800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.