Individual
CARRIE LYNN VITKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
400 E. 2ND ST., CENTENNIAL HALL, BLOOMSBURG, PA 17815-1301
(570) 389-5380
(570) 389-5022
Mailing address
PO BOX 1388, KINGSTON, PA 18704-0388
(570) 288-8881
(570) 288-8065
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3461
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0603
—
SC
Enumeration date
06/17/2006
Last updated
06/23/2010
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