Provider Demographics
NPI:1932361102
Name:PIETRALCZYK, KARI ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:ANN
Last Name:PIETRALCZYK
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 WELLES STREET
Mailing Address - Street 2:
Mailing Address - City:FORTY-FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-283-0524
Mailing Address - Fax:570-283-0302
Practice Address - Street 1:190 WELLES STREET
Practice Address - Street 2:
Practice Address - City:FORTY-FORT
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-283-0524
Practice Address - Fax:570-283-0302
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006075231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102207434Medicaid
PA130529ZAG9Medicare PIN