Provider Demographics
NPI:1053912097
Name:CAMERON, LISA JEAN (MS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CAMINO ENCINAS STE 210
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3350
Mailing Address - Country:US
Mailing Address - Phone:925-386-6256
Mailing Address - Fax:
Practice Address - Street 1:8 CAMINO ENCINAS STE 210
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3350
Practice Address - Country:US
Practice Address - Phone:925-386-6256
Practice Address - Fax:925-310-3187
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty