Provider Demographics
NPI:1053158675
Name:HERNANDEZ, LIZBETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:
Last Name:HERNANDEZ
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 1:3828 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-4522
Mailing Address - Country:US
Mailing Address - Phone:559-393-0045
Mailing Address - Fax:
Practice Address - Street 1:3828 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-4522
Practice Address - Country:US
Practice Address - Phone:559-393-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP29950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist