1780619650 NPI number — MISS KARIN MARIE PRYBOCK M.S., CCC-SLP

Table of content: MISS KARIN MARIE PRYBOCK M.S., CCC-SLP (NPI 1780619650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780619650 NPI number — MISS KARIN MARIE PRYBOCK M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRYBOCK
Provider First Name:
KARIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780619650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 S HIGHLAND AVE APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15206-4265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-716-3249
Provider Business Mailing Address Fax Number:
412-766-7336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 N BALPH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15202-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-761-6062
Provider Business Practice Location Address Fax Number:
412-766-7336
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL007069 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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