Individual ProviderLisa GustinSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address5606 S 147th St, Omaha, NE 68137-2648(402) 715-2350PECOS EnrollmentBased on the most recent information from CMS, provider Lisa Gustin 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 2 days ago.Profile DetailsProvider ID1619340304Provider TypeIndividualFull NameGustin, LisaTitleMs.GenderFemaleSole ProprietorNoEnumeration Date11/4/2015Last Updated11/4/2015Contact InformationPractice LocationPractice Address5606 S 147th St, Omaha, NE 68137-2648Phone(402) 715-2350FaxUnlisted FaxMailing LocationMailing Address5606 S 147th St, Omaha, NE 68137-2648Phone(402) 715-2350FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID7292892205DescriptionOtherIssuer:NDE STAFF ID 7292892205NebraskaID7292892205DescriptionOtherIssuerNDE STAFF 7292892205Nebraska