MEDICARE: MRS. ALISON ELIZABETH PRINYAVIVATKUL M.S., CCC-SLP

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	SA 7907	FL

General Provider Information

NPI Number	:	1043354277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON ELIZABETH PRINYAVIVATKUL M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	8129 PELICAN HARBOUR DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6849
Country	:	US
Telephone Number	:	561-827-6678
Fax Number	:

Provider Business Practice Location Address
First Line	:	8129 PELICAN HARBOUR DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6849
Country	:	US
Telephone Number	:	561-827-6678
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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