Individual
LISA ANDREA BLACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-A
Contact information
Practice address
1900 RITTENHOUSE SQ, C-1, PHILADELPHIA, PA 19103-5767
(215) 985-4964
(215) 985-1678
Mailing address
1900 RITTENHOUSE SQ, C-1, PHILADELPHIA, PA 19103-5767
(215) 985-4964
(215) 985-1678
Taxonomy
Speciality
Code
Description
License number
State
231HA2500X
Assistive Technology Supplier Audiologist
Primary
AT000105L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT000105L
AUDIOLOGY LICENSE
PA
Enumeration date
07/12/2006
Last updated
07/08/2007
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