Provider Demographics
NPI:1114105087
Name:KOCZAN, BLAIR ALLISON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BLAIR
Middle Name:ALLISON
Last Name:KOCZAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CREST DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1317
Mailing Address - Country:US
Mailing Address - Phone:732-996-6532
Mailing Address - Fax:
Practice Address - Street 1:17 CREST DR
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1317
Practice Address - Country:US
Practice Address - Phone:732-996-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS005235Z00000X
NJ41YS00563300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist