Provider Demographics
NPI:1104164334
Name:GROZANICK, PAMELA JAN
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JAN
Last Name:GROZANICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 GROZANICK RD
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-6501
Mailing Address - Country:US
Mailing Address - Phone:814-949-2050
Mailing Address - Fax:814-949-2051
Practice Address - Street 1:4 SHERATON DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-9316
Practice Address - Country:US
Practice Address - Phone:814-949-2050
Practice Address - Fax:814-949-2051
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001421L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist