Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 235Z00000X | Speech-Language Pathologist | | SL000071L | PENNSYLVANIA | No |
| 2 | 332B00000X | Durable Medical Equipment & Medical Supplies | | D00378 | PENNSYLVANIA | No |
| 3 | 231H00000X | Audiologist | | AT00281L | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | R06675 | MEDICARE UPIN | | |
| 2 | 101422710 0002 | MEDICAID | PENNSYLVANIA | |
| 3 | 101427710 0001 | MEDICAID | PENNSYLVANIA | |
| 4 | 4360649 | OTHER | PENNSYLVANIA | AETNA AUD |
| 5 | 0027032000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 6 | 0001511227 | OTHER | PENNSYLVANIA | INDEP BLUE CROSS |
| 7 | 30005306 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 8 | 0342973000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 9 | TO208144 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | AUD |
| 10 | 0001511228 | OTHER | PENNSYLVANIA | IBC PPO INDEP BLUE CROSS |
| 11 | 101427710 0003 | MEDICAID | PENNSYLVANIA | |