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General NPI Number Information
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NPI Number | 1487501862
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Entity Type | Individual
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Provider Name | DYLAN JAKOB LISNOW
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Gender | Male
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 170 N HENDERSON RD STE 200
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4422
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Country | US
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Telephone | 856-346-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 315 S WALNUT ST APT 5
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City | WEST CHESTER
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State | PA
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Zip | 19382-3776
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Country | US
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Telephone | 610-730-4336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | PA
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