Provider Demographics
NPI:1336313303
Name:SMOCZYK, PATRICIA MAE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MAE
Last Name:SMOCZYK
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 1:9544 178TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5670
Mailing Address - Country:US
Mailing Address - Phone:715-404-5161
Mailing Address - Fax:
Practice Address - Street 1:9544 178TH ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5670
Practice Address - Country:US
Practice Address - Phone:715-404-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI689-154235Z00000X
TX101247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43310400Medicaid