MEDICARE: LISA R PETROWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1538742366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA R PETROWSKI

Provider Business Mailing Address
First Line	:	33 HENRY J DR
Second Line	:
City	:	TEWKSBURY
State	:	MA
Zip	:	01876-3719
Country	:	US
Telephone Number	:	978-289-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 MERRIMACK ST STE 205
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1789
Country	:	US
Telephone Number	:	978-620-0290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2021
Last Update Date	:	04/29/2021

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Directions to “ LISA R PETROWSKI ” Practice Location

Language	Start Address	Practice Location

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