Provider Demographics
NPI:1114443470
Name:KROMKOWSKI, DANA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KROMKOWSKI
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 1:8920 HARRISON PKWY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3587
Mailing Address - Country:US
Mailing Address - Phone:574-286-6847
Mailing Address - Fax:
Practice Address - Street 1:8920 HARRISON PARKWAY
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4603
Practice Address - Country:US
Practice Address - Phone:574-286-6847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006325A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200000000AMedicaid