Provider Demographics
NPI:1427201854
Name:LANDSKRONER, LISA BETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETH
Last Name:LANDSKRONER
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 1:400 FORDHAM PL
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5369
Mailing Address - Country:US
Mailing Address - Phone:732-598-9186
Mailing Address - Fax:732-303-1017
Practice Address - Street 1:400 FORDHAM PL
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5369
Practice Address - Country:US
Practice Address - Phone:732-598-9186
Practice Address - Fax:732-303-1017
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014964-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03669087Medicaid