Healthcare Provider Details

I. General information

NPI: 1134447394
Provider Name (Legal Business Name): KATRINA DJOKIC MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14145 SIMONE DR
SHELBY TWP MI
48315-3228
US

IV. Provider business mailing address

14145 SIMONE DR
SHELBY TWP MI
48315-3228
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-6280
  • Fax:
Mailing address:
  • Phone: 586-566-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: