Provider Demographics
NPI:1487742672
Name:PTASZEK, JUDITH L (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:PTASZEK
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 1:20800 WESTGATE MALL STE 510
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1318
Mailing Address - Country:US
Mailing Address - Phone:440-895-1309
Mailing Address - Fax:
Practice Address - Street 1:20800 WESTGATE MALL STE 510
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1318
Practice Address - Country:US
Practice Address - Phone:440-895-1309
Practice Address - Fax:440-895-1309
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.4391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341929047OtherTAX IDENTIFICATION NUMBER