Provider Demographics
NPI:1558103135
Name:MENTRIKOSKI, AUDRALAINE N
Entity type:Individual
Prefix:
First Name:AUDRALAINE
Middle Name:N
Last Name:MENTRIKOSKI
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-895-5020
Mailing Address - Fax:570-214-9878
Practice Address - Street 1:126 MARKET WAY
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1039
Practice Address - Country:US
Practice Address - Phone:570-895-5020
Practice Address - Fax:570-214-9878
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL018406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist