Provider Demographics
NPI:1801913694
Name:REALE, LISA A (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:A
Last Name:REALE
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 1:2434 SMALLMAN ST
Mailing Address - Street 2:UNIT 412
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-4671
Mailing Address - Country:US
Mailing Address - Phone:724-355-0118
Mailing Address - Fax:
Practice Address - Street 1:2434 SMALLMAN ST
Practice Address - Street 2:UNIT 412
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-4671
Practice Address - Country:US
Practice Address - Phone:724-355-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist