Individual
LINDA RUNNELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 BONAIR DR, WILLIAMSPORT, PA 17701-9335
(570) 323-7077
Mailing address
1120 BONAIR DR, WILLIAMSPORT, PA 17701-9335
(570) 323-7077
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
080128589
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275739955
—
PA
Enumeration date
04/06/2011
Last updated
06/19/2014
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