Provider Demographics
NPI:1790376804
Name:PAUCHNIK, LYDIA SUSANNA
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:SUSANNA
Last Name:PAUCHNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MOUNTAIN SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:PA
Mailing Address - Zip Code:17841-9260
Mailing Address - Country:US
Mailing Address - Phone:717-856-8181
Mailing Address - Fax:
Practice Address - Street 1:1001 MOUNTAIN SPRINGS LN
Practice Address - Street 2:
Practice Address - City:MC CLURE
Practice Address - State:PA
Practice Address - Zip Code:17841-9260
Practice Address - Country:US
Practice Address - Phone:717-856-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-04-07
Deactivation Date:2021-02-17
Deactivation Code:
Reactivation Date:2021-04-07
Provider Licenses
StateLicense IDTaxonomies
PA013926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist