Provider Demographics
NPI:1699750224
Name:PRYOR, JAN CAROL (MA)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:CAROL
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:SPEIRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5040 BEVIL ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-1502
Mailing Address - Country:US
Mailing Address - Phone:916-456-5331
Mailing Address - Fax:
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-5850
Practice Address - Fax:916-457-8214
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist