Provider Demographics
NPI:1851768444
Name:KOSS, DEANNA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:KOSS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:ROBERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 DAFFODIL WAY
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3592
Mailing Address - Country:US
Mailing Address - Phone:908-720-7121
Mailing Address - Fax:
Practice Address - Street 1:22 DAFFODIL WAY
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3592
Practice Address - Country:US
Practice Address - Phone:908-720-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00811200235Z00000X
NY024696235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04602640Medicaid