Individual
EWA GAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
45B W MAIN ST # B, ANNVILLE, PA 17003-1319
(917) 348-5018
Mailing address
45B W MAIN ST # B, ANNVILLE, PA 17003-1319
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL011820
PA
235Z00000X
Speech-Language Pathologist
SLP10413
AZ
Other
Enumeration date
03/17/2017
Last updated
03/17/2017
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