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General NPI Number Information
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NPI Number | 1861306557
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Entity Type | Individual
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Provider Name | JANE ANTONCZAK
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Gender | Female
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 581 TAYLOR RD
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City | BRIGHTON
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State | MI
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Zip | 48114-7613
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Country | US
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Telephone | 810-626-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 30490 MUNGER DR
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City | LIVONIA
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State | MI
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Zip | 48154-3270
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Country | US
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Telephone | 248-719-2885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101001811
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License Number State | MI
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