Provider Demographics
NPI:1144702911
Name:KOKOSZYNA, KELLY ANN (MA-CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:KOKOSZYNA
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18905 FALCON POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3068
Mailing Address - Country:US
Mailing Address - Phone:512-736-4134
Mailing Address - Fax:
Practice Address - Street 1:18905 FALCON POINTE BLVD
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3068
Practice Address - Country:US
Practice Address - Phone:512-736-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist