Provider Demographics
NPI:1609021716
Name:SITKOWSKI, DANA L
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:L
Last Name:SITKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-8776
Mailing Address - Country:US
Mailing Address - Phone:870-492-2008
Mailing Address - Fax:
Practice Address - Street 1:62 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-8776
Practice Address - Country:US
Practice Address - Phone:870-492-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#939235Z00000X
MD01111505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127662721Medicaid