Provider Demographics
NPI:1184392177
Name:PROKOPOWICZ, PATRYCJA A (MS)
Entity type:Individual
Prefix:
First Name:PATRYCJA
Middle Name:A
Last Name:PROKOPOWICZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3534
Mailing Address - Country:US
Mailing Address - Phone:786-473-4420
Mailing Address - Fax:
Practice Address - Street 1:14411 COMMERCE WAY STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1598
Practice Address - Country:US
Practice Address - Phone:305-625-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist