Provider Demographics
NPI:1003230160
Name:KORTYKA, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:KORTYKA
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 1:1471 LAUDERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3629
Mailing Address - Country:US
Mailing Address - Phone:440-454-1584
Mailing Address - Fax:
Practice Address - Street 1:13701 LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-1440
Practice Address - Country:US
Practice Address - Phone:440-602-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist