Doctor Name: | BETH ANN KICSAK |
NPI Number: | 1336424415 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 012610-1 |
Business Practice Address: | 36 Talcott St Owego, NY - 138271023 |
Business Phone Number: | 6076876226 |
Business Fax Number: | |
Mailing Address: | 294 Pitkin Hill Rd, JOHNSON CITY |
State: | NY |
Postal Code: | 137904421 |
Phone Number: | 6077850524 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2011 |
NPI Last Update Date: | 10/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 012610-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |