Lisa Claire Cannon, MS CCC A
Individual provider Active NPI Audiologist · Clovis, NM
NPI 1801965959 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801965959
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- 2459 (NM)
- Practice address
- 1600 Sutter PL
Clovis, NM 88101-4611 - Phone
- (505) 769-4490
- Fax
- (505) 935-0011
- NPI assigned
- Nov 6, 2006
- 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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2459 | NM | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clovis Municipal Schools | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 2459 | NM | Yes |
Addresses
Primary practice location
1600 Sutter PL
Clovis, NM 88101-4611
Mailing address
1427 Colonial Pkwy
Clovis, NM 88101-3107
Phone (505) 742-1976
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000Z7838 | Medicaid | NM |
Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.