Doctor Name: | DR. LISA MARIE EVANGELISTA |
NPI Number: | 1780910166 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CSCD |
License Number: | 18354 |
Business Practice Address: | 2521 Stockton Blvd Ste 4300 Sacramento, CA - 958172207 |
Business Phone Number: | 9167345400 |
Business Fax Number: | |
Mailing Address: | 2521 Stockton Blvd Ste 4300, SACRAMENTO |
State: | CA |
Postal Code: | 958172207 |
Phone Number: | 9167345400 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2009 |
NPI Last Update Date: | 05/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 18354 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |