Provider Demographics
NPI:1477179182
Name:KOESTERMAN, ELLEN YAEGER
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:YAEGER
Last Name:KOESTERMAN
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 1:290 POAGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4127
Mailing Address - Country:US
Mailing Address - Phone:513-680-5021
Mailing Address - Fax:
Practice Address - Street 1:5180 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3701
Practice Address - Country:US
Practice Address - Phone:513-636-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist