Provider Demographics
NPI:1447714084
Name:KWIATKOWSKI, RICHARD JR (SLP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:KWIATKOWSKI
Suffix:JR
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 CORVETTE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1033
Mailing Address - Country:US
Mailing Address - Phone:856-397-9116
Mailing Address - Fax:
Practice Address - Street 1:280 MIDDLE HOLLAND RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-4822
Practice Address - Country:US
Practice Address - Phone:215-322-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01076900235Z00000X
PASL015025235Z00000X
FLSA21113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist