Provider Demographics
NPI:1003038654
Name:PACOVSKY, FRANK JOHN (AUD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:JOHN
Last Name:PACOVSKY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MADISON AVE STE 614
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5488
Mailing Address - Country:US
Mailing Address - Phone:507-995-6090
Mailing Address - Fax:507-594-9292
Practice Address - Street 1:1400 MADISON AVE STE 614
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5488
Practice Address - Country:US
Practice Address - Phone:507-995-6090
Practice Address - Fax:507-594-9292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5960231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN138023100Medicaid