Provider Demographics
NPI:1568809960
Name:KOSTER, SETH
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:KOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 MORNING STAR DR UNIT 3901
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1786
Mailing Address - Country:US
Mailing Address - Phone:734-800-1677
Mailing Address - Fax:
Practice Address - Street 1:3650 MORNING STAR DR UNIT 3901
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1786
Practice Address - Country:US
Practice Address - Phone:734-800-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07090235Z00000X
IN22007011A235Z00000X
LA8200235Z00000X
NMSLP7382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist