Provider Demographics
NPI:1063659159
Name:KOSTER, SARA R (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:R
Last Name:KOSTER
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 1:8532 124TH ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3309
Mailing Address - Country:US
Mailing Address - Phone:718-441-3625
Mailing Address - Fax:718-441-3625
Practice Address - Street 1:8532 124TH ST
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3309
Practice Address - Country:US
Practice Address - Phone:718-441-3625
Practice Address - Fax:718-441-3625
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist