Provider Demographics
NPI:1205488525
Name:MATSCHNER, LISA ANNE (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:MATSCHNER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 PLEASANT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6153
Mailing Address - Country:US
Mailing Address - Phone:407-375-4745
Mailing Address - Fax:
Practice Address - Street 1:506 PLEASANT GROVE DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6153
Practice Address - Country:US
Practice Address - Phone:407-375-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty