Provider Demographics
NPI:1740622752
Name:PAVICH, AMY ELIZABETH (MA, SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:PAVICH
Suffix:
Gender:F
Credentials:MA, SLP, TSSLD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:HOUTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP, TSSLD
Mailing Address - Street 1:2069 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2033
Mailing Address - Country:US
Mailing Address - Phone:917-295-8084
Mailing Address - Fax:
Practice Address - Street 1:3636 10TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:718-383-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist