Provider Demographics
NPI:1063847226
Name:MROCZEK, JENNA LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LEE
Last Name:MROCZEK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LAKEFRONT DR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2215
Mailing Address - Country:US
Mailing Address - Phone:410-785-3854
Mailing Address - Fax:
Practice Address - Street 1:102 LAKEFRONT DR
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2215
Practice Address - Country:US
Practice Address - Phone:410-785-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6022235Z00000X
MD07438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist