Provider Demographics
NPI:1275165110
Name:KOZMINSKI, CHRISTA LYNN
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LYNN
Last Name:KOZMINSKI
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 1:141 STITT LN
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-8525
Mailing Address - Country:US
Mailing Address - Phone:814-207-5843
Mailing Address - Fax:
Practice Address - Street 1:100 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-1982
Practice Address - Country:US
Practice Address - Phone:814-342-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist