Anastasia Antoniadis, CCC/SLP
Individual provider Active NPI Speech-Language Pathologist · Devon, PA
NPI 1922439819 · NPPES record last updated Jan 3, 2014
Key facts
- NPI
- 1922439819
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SL002379L (PA)
- Practice address
- 62 Old Forge Xing
Devon, PA 19333-1119 - Phone
- (610) 202-9060
- NPI assigned
- Dec 3, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL002379L | PA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SL002379L | PA | Yes |
Addresses
Primary practice location
62 Old Forge Xing
Devon, PA 19333-1119
Mailing address
62 Old Forge Xing
Devon, PA 19333-1119
Phone (610) 202-9060
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All providers in Devon, PA · Speech-Language Pathologist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.