Provider Demographics
NPI:1770035446
Name:ACHIRON, EDWARD ARTHUR (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ARTHUR
Last Name:ACHIRON
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346-7768
Mailing Address - Country:US
Mailing Address - Phone:570-350-4453
Mailing Address - Fax:
Practice Address - Street 1:5223 5TH AVE
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346-7768
Practice Address - Country:US
Practice Address - Phone:570-350-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist