Provider Demographics
NPI:1457049751
Name:KOHARSKI, ZACHARY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:KOHARSKI
Suffix:
Gender:M
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 1:6024 RIDGE AVE STE 116-205
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1601
Mailing Address - Country:US
Mailing Address - Phone:215-278-9228
Mailing Address - Fax:
Practice Address - Street 1:6024 RIDGE AVE STE 116-205
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1601
Practice Address - Country:US
Practice Address - Phone:215-278-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist