Basic Information
| Provider Information | |||||||||
| NPI: | 1053514562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOHLBUS | ||||||||
| FirstName: | CARIN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CUSMA | ||||||||
| OtherFirstName: | CARIN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS CCC SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1780 KENDARBREN DRIVE | ||||||||
| Address2: | INVO HEALTH CARE ASSOCIATES | ||||||||
| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Practice Location | |||||||||
| Address1: | 1780 KENDARBREN DRIVE | ||||||||
| Address2: | INVO HEALTH CARE ASSOCIATES | ||||||||
| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL001409L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0017343420007 | 01 | PA | MA NUMBER | OTHER |