Provider Demographics
NPI:1467230367
Name:STOLARSKI, JONATHAN (C-SLPA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:STOLARSKI
Suffix:
Gender:M
Credentials:C-SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 THUROW ST
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3033
Mailing Address - Country:US
Mailing Address - Phone:847-877-3622
Mailing Address - Fax:
Practice Address - Street 1:123 E 6TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4603
Practice Address - Country:US
Practice Address - Phone:918-938-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSLPA3412355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant