Provider Demographics
NPI:1003118134
Name:ROCCO, LISA R (CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:ROCCO
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC, SLP
Mailing Address - Street 1:517 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4447
Mailing Address - Country:US
Mailing Address - Phone:610-524-0973
Mailing Address - Fax:610-524-0973
Practice Address - Street 1:615 EAST BOOT RD
Practice Address - Street 2:BELLINGHAM RETIREMENT COMMUNITY
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-0000
Practice Address - Country:US
Practice Address - Phone:484-653-4426
Practice Address - Fax:610-692-4630
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003346L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist