Provider Demographics
NPI:1457832586
Name:KOS, BERNADETTE (MA)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:KOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ILLINOIS AVE STE A104
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7972
Mailing Address - Country:US
Mailing Address - Phone:865-388-0737
Mailing Address - Fax:865-383-0015
Practice Address - Street 1:700 S ILLINOIS AVE STE A104
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7972
Practice Address - Country:US
Practice Address - Phone:865-383-0737
Practice Address - Fax:865-383-0015
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1923237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter