Provider Demographics
NPI:1417129198
Name:AMOS, LISA BLASKO
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BLASKO
Last Name:AMOS
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 1:442 SAW MILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-2049
Mailing Address - Country:US
Mailing Address - Phone:610-513-5218
Mailing Address - Fax:
Practice Address - Street 1:625 W RIDGE PIKE STE C105
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1192
Practice Address - Country:US
Practice Address - Phone:610-834-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist