Provider Demographics
NPI:1356759559
Name:ALEXANDER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRACETON
Mailing Address - State:PA
Mailing Address - Zip Code:15748-7115
Mailing Address - Country:US
Mailing Address - Phone:724-479-3164
Mailing Address - Fax:
Practice Address - Street 1:2000 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:DAVIDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15928-9220
Practice Address - Country:US
Practice Address - Phone:814-288-2724
Practice Address - Fax:814-288-2387
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004534L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist