Provider Demographics
NPI:1417065145
Name:PANCHIK, ANN MECKLEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MECKLEY
Last Name:PANCHIK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9775
Mailing Address - Country:US
Mailing Address - Phone:717-979-1815
Mailing Address - Fax:
Practice Address - Street 1:950 FRONT ST
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-9775
Practice Address - Country:US
Practice Address - Phone:717-979-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004294L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003678 0005OtherPROMISE ID/SERVICE LOCAT