Lisa Black
Individual provider Active NPI Speech-Language Pathologist · Suwanee, GA
NPI 1801255161 · NPPES record last updated Feb 10, 2020
Key facts
- NPI
- 1801255161
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 14052341 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14052341 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bright Horizons Pediatric Therapy, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 14052341 | GA | Yes |
Addresses
Primary practice location
5400 Laurel Springs Pkwy
BLDG 400 #404
Suwanee, GA 30024-6056
Mailing address
2355 Ashton Dr
Roswell, GA 30076-4233
Phone (858) 472-3022
Other providers in Suwanee, GA
- Paige Bidwell
- Joanne Bien-Aime
- Billy Adams, LPC, LLC
- Ellen Biros
- Brantley Black Bruce
- Evan Blackburn
- Brittany Bledsoe
- Blossom Pediatric Dentistry, LLC
- Blpodiatry LLC
- Emily Blum
All providers in Suwanee, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.