=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073009890
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN FRANCINE PAHOSKI MA, CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2018
-----------------------------------------------------
Last Update Date | 07/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W HOSPITAL ST
-----------------------------------------------------
City | TAYLOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18517-2012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-562-2102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 RIDGE ST
-----------------------------------------------------
City | CLARKS SUMMIT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18411-1053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-575-7633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SL004052L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------