Provider Demographics
NPI:1760683858
Name:PROVAD-PROFESSIONAL VOICE ADVANTAGE
Entity Type:Organization
Organization Name:PROVAD-PROFESSIONAL VOICE ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MECKELY
Authorized Official - Last Name:PANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:717-979-1815
Mailing Address - Street 1:950 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9775
Mailing Address - Country:US
Mailing Address - Phone:717-979-1815
Mailing Address - Fax:
Practice Address - Street 1:950 FRONT ST
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-9775
Practice Address - Country:US
Practice Address - Phone:717-979-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004294L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000036780005OtherPROMISE ID