Provider Demographics
NPI:1811227135
Name:KOSSAN, CONSTANCE (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:KOSSAN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FORD BLDG
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-3000
Mailing Address - Country:US
Mailing Address - Phone:814-863-2290
Mailing Address - Fax:814-863-3759
Practice Address - Street 1:110 FORD BLDG
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-3000
Practice Address - Country:US
Practice Address - Phone:814-863-2290
Practice Address - Fax:814-863-3759
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004459L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist