Provider Demographics
NPI:1801922067
Name:SKRAITZ, VICKI RAE (SLP)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:RAE
Last Name:SKRAITZ
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 1:103 SUGARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2304
Mailing Address - Country:US
Mailing Address - Phone:724-941-2100
Mailing Address - Fax:724-941-0239
Practice Address - Street 1:4160 WASHINGTON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2533
Practice Address - Country:US
Practice Address - Phone:724-941-2100
Practice Address - Fax:724-941-0239
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001825824OtherHIGHMARK PROVIDER NUMBER