Lisette Hernandez, SLP

Individual provider Active NPI Speech-Language Pathologist · Monroe, GA

NPI 1679697692 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1679697692
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SLP005291 (GA)
Practice address
226 Alcovy St
Suite G-1
Monroe, GA 30655-2183
Phone
(770) 207-9043
Fax
(770) 207-9029
NPI assigned
Mar 16, 2007
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SLP005291GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Children & Adult Therapy Services Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP005291 GA Yes

Addresses

Primary practice location

226 Alcovy St
Suite G-1
Monroe, GA 30655-2183

Mailing address

226 Alcovy St
Suite G-1, P.O. Box 1250
Monroe, GA 30655-2183
Phone (770) 207-9043

Other providers in Monroe, GA

All providers in Monroe, GA · Speech-Language Pathologist in Georgia

Sources for this page

Verify at the official NPI Registry.