MEDICARE: BEATRICE PAVLIK

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	7101008201	MI

General Provider Information

NPI Number	:	1457157430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE PAVLIK

Provider Business Mailing Address
First Line	:	4140 VALLEY VISTA DR APT 103
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-7975
Country	:	US
Telephone Number	:	630-853-3269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 EDISON AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3918
Country	:	US
Telephone Number	:	616-453-2475
Fax Number	:

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

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	02/20/2025

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Directions to “ BEATRICE PAVLIK ” Practice Location

Language	Start Address	Practice Location

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