Provider Demographics
NPI:1619038387
Name:PAVLOVIC, VICTORIA SARAH (L-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SARAH
Last Name:PAVLOVIC
Suffix:
Gender:F
Credentials:L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SQUIRREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-6021
Mailing Address - Country:US
Mailing Address - Phone:845-534-1258
Mailing Address - Fax:
Practice Address - Street 1:18 SQUIRREL HILL RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-6021
Practice Address - Country:US
Practice Address - Phone:845-534-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010995-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist