Basic Information
| Provider Information | |||||||||
| NPI: | 1003480310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAWROCKI | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | WIGFIELD | ||||||||
| OtherFirstName: | STACY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3916 DAVID RD | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165106318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144644859 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 41 W GORE RD | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165093621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148644867 | ||||||||
| FaxNumber: | 3174495783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2021 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.