Basic Information
| Provider Information | |||||||||
| NPI: | 1629251392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSOWSKY | ||||||||
| FirstName: | ALICE | ||||||||
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| Credential: | MA MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 SPRING GARDEN ST | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065171913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032871390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 MASONIC AVE | ||||||||
| Address2: | |||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064923048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036796909 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2007 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 001562 | CT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.