Provider Demographics
NPI:1538859293
Name:HORTON, LISA RENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:HORTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-0882
Mailing Address - Country:US
Mailing Address - Phone:806-228-6109
Mailing Address - Fax:806-434-1637
Practice Address - Street 1:13795 FM 376 # 882
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-6775
Practice Address - Country:US
Practice Address - Phone:806-228-6109
Practice Address - Fax:806-434-1637
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104848235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist