Provider Demographics
NPI:1821617275
Name:PIERONEK, JOLIE BETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:BETH
Last Name:PIERONEK
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 1:3325 PATE WAY
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-8459
Mailing Address - Country:US
Mailing Address - Phone:972-838-2602
Mailing Address - Fax:972-837-4176
Practice Address - Street 1:3325 PATE WAY
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-8459
Practice Address - Country:US
Practice Address - Phone:972-838-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14045292OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION
TX107519OtherTEXAS STATE SLP LICENSE