Provider Demographics
NPI:1841622883
Name:PANKEWICZ, LORIN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORIN
Middle Name:
Last Name:PANKEWICZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LORIN
Other - Middle Name:
Other - Last Name:VIGLIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:8200 FLINT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-6411
Mailing Address - Country:US
Mailing Address - Phone:330-507-4440
Mailing Address - Fax:
Practice Address - Street 1:867 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3309
Practice Address - Country:US
Practice Address - Phone:330-507-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OHSP.11265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841622883OtherPRIVATE INSURANCE