Provider Demographics
NPI:1235015199
Name:TREVISO, LISA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TREVISO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 ZENOBIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2406
Mailing Address - Country:US
Mailing Address - Phone:720-841-6420
Mailing Address - Fax:
Practice Address - Street 1:ANSCHUTZ MEDICAL CAMPUS MAIL STOP F796
Practice Address - Street 2:12605 E 16TH AVENUE
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-841-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist