Provider Demographics
NPI:1528029444
Name:DWOREK, KRISTINA L (MS)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:DWOREK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:L
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0545
Mailing Address - Country:US
Mailing Address - Phone:814-677-6381
Mailing Address - Fax:814-677-6384
Practice Address - Street 1:2 PARK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2413
Practice Address - Country:US
Practice Address - Phone:814-677-6381
Practice Address - Fax:814-677-6384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000767L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP92046Medicare UPIN