Provider Demographics
NPI:1649143561
Name:KOOSED, JOANNE LYNN
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:LYNN
Last Name:KOOSED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PONTIUS RD
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2302
Mailing Address - Country:US
Mailing Address - Phone:330-819-8095
Mailing Address - Fax:
Practice Address - Street 1:525 PONTIUS RD
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2302
Practice Address - Country:US
Practice Address - Phone:330-819-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker