Provider Demographics
NPI:1649795972
Name:DRENZEK, MARY KATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:DRENZEK
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 1:1486 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06093-3306
Mailing Address - Country:US
Mailing Address - Phone:860-292-0376
Mailing Address - Fax:
Practice Address - Street 1:1486 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WEST SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06093-3306
Practice Address - Country:US
Practice Address - Phone:860-292-0376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist