Provider Demographics
NPI:1831482900
Name:LISTON, DANA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:LISTON
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 1:5101 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4643
Mailing Address - Country:US
Mailing Address - Phone:856-665-9111
Mailing Address - Fax:
Practice Address - Street 1:5101 N PARK DR
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4643
Practice Address - Country:US
Practice Address - Phone:856-665-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00571300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist