Individual
MS. JACLYN ISIS LISBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MACCC-SLP
Contact information
Practice address
130 NORTH 2ND STREET-#2E, PHILADELPHIA, PA 19106
(610) 316-1532
Mailing address
130 NORTH 2ND STREET-#2E, PHILADELPHIA, PA 19106
(610) 316-1532
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL009109
PA
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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