Provider Demographics
NPI:1265056030
Name:PRONGER, JUDITH GUADALUPE (BS-SLPA)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:GUADALUPE
Last Name:PRONGER
Suffix:
Gender:F
Credentials:BS-SLPA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:GUADALUPE
Other - Last Name:PIORKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3670 S CICELY AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-4413
Mailing Address - Country:US
Mailing Address - Phone:480-823-3651
Mailing Address - Fax:
Practice Address - Street 1:1525 31ST AVE SW STE C2
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-2016
Practice Address - Country:US
Practice Address - Phone:701-857-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2744235Z00000X
AZSLPA123052355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant