Provider Demographics
NPI:1073086609
Name:SLODYSKO, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SLODYSKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1425
Mailing Address - Country:US
Mailing Address - Phone:570-274-3124
Mailing Address - Fax:
Practice Address - Street 1:611 LYCOMING MALL CIR
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-1826
Practice Address - Country:US
Practice Address - Phone:570-308-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03260237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist