Provider Demographics
NPI:1861681538
Name:CAPOZZOLI, LISA KANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KANE
Last Name:CAPOZZOLI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4333
Mailing Address - Country:US
Mailing Address - Phone:724-223-7803
Mailing Address - Fax:724-223-7804
Practice Address - Street 1:190 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4349
Practice Address - Country:US
Practice Address - Phone:724-223-7803
Practice Address - Fax:724-223-7804
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist