Provider Demographics
NPI:1316654387
Name:KWAPISZ, JACQUELINE TRUDY
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:TRUDY
Last Name:KWAPISZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23625 JOY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2535
Mailing Address - Country:US
Mailing Address - Phone:586-944-9454
Mailing Address - Fax:
Practice Address - Street 1:3178 HILTON RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1059
Practice Address - Country:US
Practice Address - Phone:248-629-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist