Individual
SHANNON PRAVETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
228 WHEATSWORTH RD, HAMBURG, NJ 07419-2620
(845) 325-0124
(973) 827-8421
Mailing address
228 WHEATSWORTH RD, HAMBURG, NJ 07419-2620
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0135191
NY
235Z00000X
Speech-Language Pathologist
41YS00459700
NJ
Other
Enumeration date
09/16/2012
Last updated
09/16/2012
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