Provider Demographics
NPI:1932790656
Name:PANKO, ALICE LOUISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:LOUISE
Last Name:PANKO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:LOUISE
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 N OREGON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3333
Mailing Address - Country:US
Mailing Address - Phone:915-533-1388
Mailing Address - Fax:915-533-2933
Practice Address - Street 1:1900 N OREGON ST STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3333
Practice Address - Country:US
Practice Address - Phone:915-533-1388
Practice Address - Fax:915-533-2933
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist