MEDICARE: MARY BETH PACCHIONI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL013957	PA

General Provider Information

NPI Number	:	1881188670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH PACCHIONI

Provider Business Mailing Address
First Line	:	1126 TWIN STACKS DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-8505
Country	:	US
Telephone Number	:	570-674-7963
Fax Number	:	570-674-7934

Provider Business Practice Location Address
First Line	:	1126 TWIN STACKS DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-8505
Country	:	US
Telephone Number	:	570-674-7963
Fax Number	:	570-674-7934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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Directions to “ MARY BETH PACCHIONI ” Practice Location

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