Provider Demographics
NPI:1013221498
Name:MISERICORDIA UNIVERSITY SPEECH-LANGUAGE AND HEARING CENTER
Entity Type:Organization
Organization Name:MISERICORDIA UNIVERSITY SPEECH-LANGUAGE AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISE PRESIDENT FINANCE AND ADMINIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RISBOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-674-6324
Mailing Address - Street 1:301 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1008
Mailing Address - Country:US
Mailing Address - Phone:570-674-8050
Mailing Address - Fax:570-255-3375
Practice Address - Street 1:301 LAKE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1008
Practice Address - Country:US
Practice Address - Phone:570-674-8050
Practice Address - Fax:570-255-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003615L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency