Provider Demographics
NPI:1134455108
Name:SAMMANASUPOKORZYNSKI, STELLA MARY (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:MARY
Last Name:SAMMANASUPOKORZYNSKI
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 WYNDHAM LN
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-7957
Mailing Address - Country:US
Mailing Address - Phone:989-464-7575
Mailing Address - Fax:
Practice Address - Street 1:2200 WYNDHAM LN
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-7957
Practice Address - Country:US
Practice Address - Phone:989-464-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist