Provider Demographics
NPI:1477850717
Name:VISNESKI, LISA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:VISNESKI
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 1:301 LAKE ST # 370
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-7752
Mailing Address - Country:US
Mailing Address - Phone:570-266-2920
Mailing Address - Fax:
Practice Address - Street 1:301 LAKE ST # 370
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-7752
Practice Address - Country:US
Practice Address - Phone:570-266-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist