Provider Demographics
NPI:1417277914
Name:ZAVACKY, RYANNE (MS, SLP)
Entity Type:Individual
Prefix:
First Name:RYANNE
Middle Name:
Last Name:ZAVACKY
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 CROQUET DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2466
Mailing Address - Country:US
Mailing Address - Phone:910-742-4857
Mailing Address - Fax:910-791-0846
Practice Address - Street 1:2561 CROQUET DR
Practice Address - Street 2:UNIT 3
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2466
Practice Address - Country:US
Practice Address - Phone:910-742-4857
Practice Address - Fax:910-791-0846
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413442Medicare UPIN