Doctor Name: | MRS. LISA RENEE BANUELOS-MARTIN |
NPI Number: | 1962738112 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CCC-SLP |
License Number: | 1225 |
Business Practice Address: | 601 Robin Ln Livingston, MT - 590473810 |
Business Phone Number: | 4062227231 |
Business Fax Number: | 4062222435 |
Mailing Address: | 504 S 13th St, LIVINGSTON |
State: | MT |
Postal Code: | 590473727 |
Phone Number: | 4062223541 |
Fax Number: | 4068236287 |
NPI Enumeration Date: | 10/22/2009 |
NPI Last Update Date: | 03/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1225 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
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 |