Provider Demographics
NPI:1376863860
Name:ZOSTANT, KERRY (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:ZOSTANT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 PADEN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4531
Mailing Address - Country:US
Mailing Address - Phone:607-757-2137
Mailing Address - Fax:607-757-2878
Practice Address - Street 1:715 PADEN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4531
Practice Address - Country:US
Practice Address - Phone:607-757-2137
Practice Address - Fax:607-757-2878
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012133-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12041852OtherASHA CERTIFICATE OF CLINICAL COMPETENCE
NY012133-1OtherNYS LICENSE AS SPEECH LANGUAGE PATHOLOGIST