Provider Demographics
NPI:1043354277
Name:PRINYAVIVATKUL, ALISON ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:ELIZABETH
Last Name:PRINYAVIVATKUL
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 1:8129 PELICAN HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6849
Mailing Address - Country:US
Mailing Address - Phone:561-827-6678
Mailing Address - Fax:
Practice Address - Street 1:8129 PELICAN HARBOUR DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6849
Practice Address - Country:US
Practice Address - Phone:561-827-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist