Provider Demographics
NPI:1316594864
Name:KOLASA, CYNTHIA KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:KATHLEEN
Last Name:KOLASA
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 1:9800 S TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3554
Mailing Address - Country:US
Mailing Address - Phone:708-423-1690
Mailing Address - Fax:
Practice Address - Street 1:9800 S TRIPP AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3554
Practice Address - Country:US
Practice Address - Phone:708-423-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist