Provider Demographics
NPI:1417120403
Name:WIRHANAWSKI, PAUL (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:WIRHANAWSKI
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1231
Mailing Address - Country:US
Mailing Address - Phone:570-383-6525
Mailing Address - Fax:570-383-4961
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1231
Practice Address - Country:US
Practice Address - Phone:570-383-6525
Practice Address - Fax:570-383-4961
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO2677237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist