Provider Demographics
NPI:1912327586
Name:ROCKS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROCKS
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 1:2205 MOUNT VERNON ST
Mailing Address - Street 2:3F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3114
Mailing Address - Country:US
Mailing Address - Phone:215-512-1026
Mailing Address - Fax:
Practice Address - Street 1:2205 MOUNT VERNON ST
Practice Address - Street 2:3F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3114
Practice Address - Country:US
Practice Address - Phone:215-512-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL0100092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist