Provider Demographics
NPI:1689073728
Name:PANKEWICZ, TRICIA ANN
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:ANN
Last Name:PANKEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5575 ELLINGER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7538
Mailing Address - Country:US
Mailing Address - Phone:330-501-4696
Mailing Address - Fax:
Practice Address - Street 1:1512 S US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9198
Practice Address - Country:US
Practice Address - Phone:330-501-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND 2014165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist