Healthcare Provider Details

I. General information

NPI: 1790035491
Provider Name (Legal Business Name): DANA CHRISTINE JOKOVICH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA CHRISTINE SPROUSE SLP

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8446 CHICKASAW WAY
PLAIN CITY OH
43064-2632
US

IV. Provider business mailing address

8446 CHICKASAW WAY
PLAIN CITY OH
43064-2632
US

V. Phone/Fax

Practice location:
  • Phone: 419-707-1529
  • Fax:
Mailing address:
  • Phone: 419-707-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP14767
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: