Provider Demographics
NPI:1003852377
Name:LOUSER, KEVIN J (MASLP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:LOUSER
Suffix:
Gender:M
Credentials:MASLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:51 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2351
Mailing Address - Country:US
Mailing Address - Phone:631-744-4191
Mailing Address - Fax:631-744-4191
Practice Address - Street 1:51 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-2351
Practice Address - Country:US
Practice Address - Phone:631-335-6381
Practice Address - Fax:631-744-4191
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014885OtherNYS LISCENCE
NY$$$$$$$$$OtherSSN