Provider Demographics
NPI:1477640092
Name:HALL-GRZYBOWSKI, NIKOL LYNN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:NIKOL
Middle Name:LYNN
Last Name:HALL-GRZYBOWSKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1508
Mailing Address - Country:US
Mailing Address - Phone:570-963-1278
Mailing Address - Fax:570-963-1292
Practice Address - Street 1:2010 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1508
Practice Address - Country:US
Practice Address - Phone:570-963-1278
Practice Address - Fax:570-963-1292
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016834890001Medicaid
PA1016834890001Medicaid