Lisa Renee Banuelos-Martin, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1225 Issued in MT

Practice address

601 Robin LN
Livingston, MT 59047-3810

Phone

(406) 222-7231

Fax

(406) 222-2435

NPI assigned

Oct 22, 2009

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

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394496000000",
    "number": "1962738112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S 13TH ST",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "590473727",
            "telephone_number": "406-222-3541",
            "fax_number": "406-823-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ROBIN LN",
            "city": "LIVINGSTON",
            "state": "MT",
            "postal_code": "590473810",
            "telephone_number": "406-222-7231",
            "fax_number": "406-222-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANUELOS-MARTIN",
        "first_name": "LISA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-22",
        "last_updated": "2014-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MT",
            "license": "1225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Livingston, MT
• Providers in Livingston, MT by specialty
• Speech-Language Pathologist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; 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.