Provider Demographics
NPI:1730966391
Name:ZAGRZEBSKI, GEORGIANNA RENE
Entity type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:RENE
Last Name:ZAGRZEBSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEORGIANNA
Other - Middle Name:RENE
Other - Last Name:PRATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1412 UNION PARK DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-7766
Mailing Address - Country:US
Mailing Address - Phone:269-589-5088
Mailing Address - Fax:
Practice Address - Street 1:3905 LORRAINE PATH
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8630
Practice Address - Country:US
Practice Address - Phone:269-428-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152000766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist