Provider Demographics
NPI:1891809174
Name:FRONCZAK, STEPHANIE L (SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:FRONCZAK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 ARROWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1528
Mailing Address - Country:US
Mailing Address - Phone:716-648-9791
Mailing Address - Fax:
Practice Address - Street 1:4635 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1851
Practice Address - Country:US
Practice Address - Phone:716-505-5700
Practice Address - Fax:716-633-9351
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006796-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9211518OtherINDEPENDENT HEALTH
NY000640178001OtherBLUE CROSS/BLUE SHIELD
NY000640178001OtherCOMMUNITY BLUE
NY02263578Medicaid