Provider Demographics
NPI:1770703613
Name:BIENKOWSKI, JOHN THOMAS (MS- CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:BIENKOWSKI
Suffix:
Gender:M
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 1:7236 15TH CT NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4604
Mailing Address - Country:US
Mailing Address - Phone:727-528-3727
Mailing Address - Fax:
Practice Address - Street 1:3901 16TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-5603
Practice Address - Country:US
Practice Address - Phone:727-526-5432
Practice Address - Fax:727-526-5432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887478600Medicaid