Provider Demographics
NPI:1265663223
Name:SKROBARCZYK, MICHELLE (CSCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SKROBARCZYK
Suffix:
Gender:F
Credentials:CSCD, CCC-SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:JENSCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4455 S PADRE ISLAND DR STE 104
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5125
Mailing Address - Country:US
Mailing Address - Phone:361-792-0822
Mailing Address - Fax:361-288-4109
Practice Address - Street 1:4455 S PADRE ISLAND DR STE 104
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5125
Practice Address - Country:US
Practice Address - Phone:361-792-0822
Practice Address - Fax:361-288-4109
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX105580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282307201Medicaid