Lisa Black

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

14052341 Issued in GA

Practice address

5400 Laurel Springs Pkwy
BLDG 400 #404
Suwanee, GA 30024-6056

Phone

(678) 473-9954

Fax

(678) 931-0105

NPI assigned

Feb 15, 2016

Last updated

Feb 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Bright Horizons Pediatric Therapy, LLC

  • Hearing and Speech Clinic/Center
  • Marietta, GA
  • NPI 1447557566
  NPD (past)

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1801255161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 ASHTON DR",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764233",
            "telephone_number": "858-472-3022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 LAUREL SPRINGS PKWY",
            "address_2": "BLDG 400 #404",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246056",
            "telephone_number": "678-473-9954",
            "fax_number": "678-931-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-15",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "14052341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Bidwell, CCC-SLP
• Joanne Bien-Aime, RBT
• Billy Adams, LPC, LLC
• Ellen Biros, M.S., L.C.S.W.
• Brantley Black Bruce, CCC-SLP
• Evan Blackburn, P.T.
• Brittany Bledsoe, PHARM D.
• Blossom Pediatric Dentistry, LLC
• Blpodiatry LLC
• Emily Blum, DC

• Speech-Language Pathologist in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; 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.