Provider Demographics
NPI:1700801933
Name:BLACKMAN, LISA ANDREA (MA CCC-A)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANDREA
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 RITTENHOUSE SQ
Mailing Address - Street 2:C-1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5767
Mailing Address - Country:US
Mailing Address - Phone:215-985-4964
Mailing Address - Fax:215-985-1678
Practice Address - Street 1:1900 RITTENHOUSE SQ
Practice Address - Street 2:C-1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5767
Practice Address - Country:US
Practice Address - Phone:215-985-4964
Practice Address - Fax:215-985-1678
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000105L231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAT000105LOtherAUDIOLOGY LICENSE