Provider Demographics
NPI:1457507873
Name:LISI, MARK ANDREW (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:LISI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 COMMERCE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9198
Mailing Address - Country:US
Mailing Address - Phone:610-345-0977
Mailing Address - Fax:610-345-0986
Practice Address - Street 1:1 COMMERCE BLVD BLDG STE201
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9198
Practice Address - Country:US
Practice Address - Phone:610-345-0977
Practice Address - Fax:610-345-0986
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001027L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist