Provider Demographics
NPI:1699808287
Name:PENDRAK, ROSE MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:ROSE MARIE
Middle Name:
Last Name:PENDRAK
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 1:616 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3404
Mailing Address - Country:US
Mailing Address - Phone:570-575-4271
Mailing Address - Fax:
Practice Address - Street 1:401 PENN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1213
Practice Address - Country:US
Practice Address - Phone:570-961-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000822L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist