Provider Demographics
NPI:1194351163
Name:KINICKA, AGNIESZKA (MA)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:KINICKA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2544
Mailing Address - Country:US
Mailing Address - Phone:646-472-4891
Mailing Address - Fax:
Practice Address - Street 1:5115 N BILTMORE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2161
Practice Address - Country:US
Practice Address - Phone:608-592-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist