Provider Demographics
NPI:1821569310
Name:PAVALKO, AMANDA (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PAVALKO
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931
Mailing Address - Country:US
Mailing Address - Phone:570-590-8266
Mailing Address - Fax:
Practice Address - Street 1:1000 W OAK ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-1643
Practice Address - Country:US
Practice Address - Phone:888-929-7677
Practice Address - Fax:888-929-7677
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist