Provider Demographics
NPI:1457157430
Name:PAVLIK, BEATRICE
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:PAVLIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 VALLEY VISTA DR APT 103
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-7975
Mailing Address - Country:US
Mailing Address - Phone:630-853-3269
Mailing Address - Fax:
Practice Address - Street 1:1000 EDISON AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-3918
Practice Address - Country:US
Practice Address - Phone:616-453-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist