MEDICARE: ANTOINETTE HAMIDIAN 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	225400000X	Rehabilitation Practitioner	SL005220 L	PA
2	103TC0700X	Clinical Psychologist	PS016274	PA
3	235Z00000X	Speech-Language Pathologist	SL005220 L	PA
4	103T00000X	Psychologist	PS016274	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	976357	OTHER	PA	HIGHMARK
2	201824875	OTHER	PA	PHCS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2669826	OTHER	PA	AETNA HMO
5	7777308	OTHER	PA	AETNA PPO
6	163625	OTHER	PA	MEDPLUS
7	819422	OTHER	PA	FIRST PRIORITY

General Provider Information

NPI Number	:	1417931601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE HAMIDIAN SLP

Provider Business Mailing Address
First Line	:	851 COMMERCE BLVD
Second Line	:	SUITE 107
City	:	DICKSON CITY
State	:	PA
Zip	:	18519-1677
Country	:	US
Telephone Number	:	570-489-5561
Fax Number	:	570-489-5563

Provider Business Practice Location Address
First Line	:	116 LARCH ST STE 300
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18509-2802
Country	:	US
Telephone Number	:	570-489-5561
Fax Number	:	570-489-5563

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	01/24/2024

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Directions to “ ANTOINETTE HAMIDIAN SLP” Practice Location

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