Provider Demographics
NPI:1659962322
Name:WRONKOSKI, DEENA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:WRONKOSKI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 AMAR DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1004
Mailing Address - Country:US
Mailing Address - Phone:985-507-1453
Mailing Address - Fax:
Practice Address - Street 1:17010 OLD COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5232
Practice Address - Country:US
Practice Address - Phone:985-345-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist