Provider Demographics
NPI:1033461025
Name:VONREKOWSKI, JEFFREY ADAM (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ADAM
Last Name:VONREKOWSKI
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9361
Mailing Address - Country:US
Mailing Address - Phone:907-306-3225
Mailing Address - Fax:
Practice Address - Street 1:3691 BEN WALTERS LN STE 4
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7750
Practice Address - Country:US
Practice Address - Phone:907-235-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist