Provider Demographics
NPI:1205156189
Name:PAVICEVAC-ORTIZ, BARBARA (SLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:PAVICEVAC-ORTIZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224-43A 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2316
Mailing Address - Country:US
Mailing Address - Phone:917-660-6290
Mailing Address - Fax:
Practice Address - Street 1:224-43A 64TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-2316
Practice Address - Country:US
Practice Address - Phone:917-660-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016138-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist