Provider Demographics
NPI:1447450630
Name:PAVLICK, CRYSTAL C (MSP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:C
Last Name:PAVLICK
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10103 COTTER CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-9243
Mailing Address - Country:US
Mailing Address - Phone:540-834-0362
Mailing Address - Fax:
Practice Address - Street 1:10103 COTTER CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-9243
Practice Address - Country:US
Practice Address - Phone:540-834-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist