Provider Demographics
NPI:1528291473
Name:BLOCK, LISA LYNN (MS, SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 HAVENHURST DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6002
Mailing Address - Country:US
Mailing Address - Phone:310-990-4981
Mailing Address - Fax:
Practice Address - Street 1:1037 HAVENHURST DR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6002
Practice Address - Country:US
Practice Address - Phone:310-990-4981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist