Provider Demographics
NPI:1114162088
Name:COHEN, LISA R (SPEECH LANGUGE PATHO)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:COHEN
Suffix:
Gender:F
Credentials:SPEECH LANGUGE PATHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GOSHEN CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3709
Mailing Address - Country:US
Mailing Address - Phone:856-988-9073
Mailing Address - Fax:
Practice Address - Street 1:1415 ROUTE 70 E
Practice Address - Street 2:SUITE 306
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2210
Practice Address - Country:US
Practice Address - Phone:856-354-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00206800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist