Provider Demographics
NPI:1619467719
Name:PROHASKA, DENISE ANN (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ANN
Last Name:PROHASKA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4399
Mailing Address - Country:US
Mailing Address - Phone:708-250-6232
Mailing Address - Fax:
Practice Address - Street 1:10317 MASON AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4399
Practice Address - Country:US
Practice Address - Phone:708-250-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty