Provider Demographics
NPI:1497020341
Name:KOSTUK, LORRINA CHRISTINE (MA CCC-SLP TSSLD/L)
Entity Type:Individual
Prefix:MISS
First Name:LORRINA
Middle Name:CHRISTINE
Last Name:KOSTUK
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 SAUNDERS SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9523
Mailing Address - Country:US
Mailing Address - Phone:716-731-6800
Mailing Address - Fax:
Practice Address - Street 1:46 COUNCIL ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4416
Practice Address - Country:US
Practice Address - Phone:716-471-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-11
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58021768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist