Provider Demographics
NPI:1265709687
Name:NOWAKOWSKI, LISA A
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:NOWAKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:299 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3818
Mailing Address - Country:US
Mailing Address - Phone:585-723-9781
Mailing Address - Fax:
Practice Address - Street 1:190 LONGRIDGE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3552
Practice Address - Country:US
Practice Address - Phone:585-966-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009745-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist