Provider Demographics
NPI:1962998666
Name:KRAKOSKY, JESSIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:KRAKOSKY
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 1:5211 79TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2832
Mailing Address - Country:US
Mailing Address - Phone:806-853-9740
Mailing Address - Fax:
Practice Address - Street 1:5211 79TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2832
Practice Address - Country:US
Practice Address - Phone:806-853-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist