Provider Demographics
NPI:1619176377
Name:PROKOP, JANA LEE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:LEE
Last Name:PROKOP
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Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:94 STEVENS RD
Mailing Address - Street 2:CHILDREN'S SPECIALIZED HOSPITAL
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1237
Mailing Address - Country:US
Mailing Address - Phone:888-244-5373
Mailing Address - Fax:732-797-3830
Practice Address - Street 1:94 STEVENS RD
Practice Address - Street 2:CHILDREN'S SPECIALIZED HOSPITAL
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1237
Practice Address - Country:US
Practice Address - Phone:888-244-5373
Practice Address - Fax:732-797-3830
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ41YS00313600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist