Provider Demographics
NPI:1598042657
Name:KRALKA, JEROME P I
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:P
Last Name:KRALKA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:KRALKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:514 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2312
Mailing Address - Country:US
Mailing Address - Phone:940-765-1111
Mailing Address - Fax:
Practice Address - Street 1:514 MEADOWBROOK ST
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-2312
Practice Address - Country:US
Practice Address - Phone:940-765-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist