Provider Demographics
NPI:1386788438
Name:LISOWSKI-LEDDY, LISA (MS,CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:LISOWSKI-LEDDY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 WILDBERRY DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1749
Mailing Address - Country:US
Mailing Address - Phone:773-294-0639
Mailing Address - Fax:
Practice Address - Street 1:1716 WILDBERRY DR UNIT B
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1749
Practice Address - Country:US
Practice Address - Phone:773-294-0639
Practice Address - Fax:888-408-8848
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist