Provider Demographics
NPI:1538742366
Name:PETROWSKI, LISA R
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:PETROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HENRY J DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3719
Mailing Address - Country:US
Mailing Address - Phone:978-289-8607
Mailing Address - Fax:
Practice Address - Street 1:370 MERRIMACK ST STE 205
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1789
Practice Address - Country:US
Practice Address - Phone:978-620-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist