Provider Demographics
NPI:1053952168
Name:GLASHAN, LISSETTE (MS, CCC-SLP, CBIS)
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:GLASHAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:LISSETTE
Other - Middle Name:
Other - Last Name:GALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:807 KINGSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3044
Mailing Address - Country:US
Mailing Address - Phone:713-725-5627
Mailing Address - Fax:
Practice Address - Street 1:5151 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7707
Practice Address - Country:US
Practice Address - Phone:214-645-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist