Provider Demographics
NPI:1649766171
Name:PAVLIK, ISABEL ANNA (MA, SLP)
Entity Type:Individual
Prefix:MISS
First Name:ISABEL
Middle Name:ANNA
Last Name:PAVLIK
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 BRYANT ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1980
Mailing Address - Country:US
Mailing Address - Phone:201-403-5279
Mailing Address - Fax:
Practice Address - Street 1:30 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2234
Practice Address - Country:US
Practice Address - Phone:716-631-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027753-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist