Provider Demographics
NPI:1861930315
Name:BUONORA, LISA (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BUONORA
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 1:74 SAVAGE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19053-1552
Mailing Address - Country:US
Mailing Address - Phone:215-582-9831
Mailing Address - Fax:
Practice Address - Street 1:74 SAVAGE DR
Practice Address - Street 2:
Practice Address - City:UPPER HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:19053-1552
Practice Address - Country:US
Practice Address - Phone:215-582-9831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004594-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004594-LOtherPA STATE LICENSE
PA0001119496OtherAMERICAN SPEECH/LANGUAGE ASSOCIATION