Lisa M Hazlett, SLP

Individual provider Active NPI Speech-Language Pathologist · Gate City, VA

NPI 1992979421 · NPPES record last updated Apr 16, 2008

Key facts

NPI
1992979421
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
2202004203 (VA)
Practice address
195 Kane Street
Gate City, VA 24251
Phone
(276) 386-2424
Fax
(276) 386-1446
NPI assigned
Apr 16, 2008
Sex
Female
Sole proprietor
Yes

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
2202004203VAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapy Innovations Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2202004203 VA Yes

Addresses

Primary practice location

195 Kane Street
Gate City, VA 24251

Mailing address

PO Box 1807
Gate City, VA 24251-4807
Phone (276) 386-2424

Other providers in Gate City, VA

All providers in Gate City, VA · Speech-Language Pathologist in Virginia

Sources for this page

Verify at the official NPI Registry.