Provider Demographics
NPI:1801178694
Name:PAVLICEK, DEAN ALLEN (MS)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:ALLEN
Last Name:PAVLICEK
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BURNTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5233
Mailing Address - Country:US
Mailing Address - Phone:701-352-4404
Mailing Address - Fax:
Practice Address - Street 1:701 W 6TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1379
Practice Address - Country:US
Practice Address - Phone:701-352-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst