Basic Information
Provider Information
NPI: 1033557335
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SIEGLER
FirstName: PNINA
MiddleName: B.
NamePrefix:  
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1062 LEMAR CIR
Address2:  
City: MERION STATION
State: PA
PostalCode: 190661109
CountryCode: US
TelephoneNumber: 6105478404
FaxNumber:  
Practice Location
Address1: 1062 LEMAR CIR
Address2:  
City: MERION STATION
State: PA
PostalCode: 190661109
CountryCode: US
TelephoneNumber: 6105478404
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2013
LastUpdateDate: 06/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X2425459PAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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