Provider Demographics
NPI:1285975003
Name:PAVELLE, ANNE DEBORAH (MA, CCC)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:DEBORAH
Last Name:PAVELLE
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 NW 17TH AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2512
Mailing Address - Country:US
Mailing Address - Phone:781-962-8862
Mailing Address - Fax:
Practice Address - Street 1:1200 NW 17TH AVE STE 12
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2512
Practice Address - Country:US
Practice Address - Phone:781-962-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11780235Z00000X
MD00168542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist