Individual ProviderLisa A TateSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address1611 Headway Cir Bldg 2, Austin, TX 78754-5165(512) 478-2581PECOS EnrollmentBased on the most recent information from CMS, provider Lisa A Tate does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1013052000Provider TypeIndividualFull NameTate, Lisa AGenderFemaleSole ProprietorNoEnumeration Date2/20/2007Last Updated5/1/2008Contact InformationPractice LocationPractice Address1611 Headway Cir Bldg 2, Austin, TX 78754-5165Phone(512) 478-2581Fax(512) 476-1638Mailing LocationMailing Address1611 Headway Cir Bldg 2, Austin, TX 78754-5165Phone(512) 478-2581Fax(512) 476-1638Provider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense18507TexasProvider IdentifiersIDDescriptionIssuerID126129901DescriptionMedicaidIssuerUnlistedTexasID021286201DescriptionMedicaidIssuerUnlistedTexasID89695TDescriptionOtherIssuerBLUE CROSSTexas