| Doctor Name: | MRS. ANN ELIZABETH MEDIANICK |
| NPI Number: | 1508164294 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M. A., M. S. |
| License Number: | PC005775 |
| Business Practice Address: | 219 W Main St Leola, PA - 175401753 |
| Business Phone Number: | 7175560149 |
| Business Fax Number: | 7175560149 |
| Mailing Address: | 219 W Main St, LEOLA |
| State: | PA |
| Postal Code: | 175401753 |
| Phone Number: | 7175560149 |
| Fax Number: | 7175560149 |
| NPI Enumeration Date: | 03/04/2011 |
| NPI Last Update Date: | 03/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC005775 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |