Provider Demographics
NPI:1649421470
Name:KOZAK, KRISTA NICOLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:NICOLE
Last Name:KOZAK
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:NICOLE
Other - Last Name:SANKOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2029 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7412
Mailing Address - Country:US
Mailing Address - Phone:610-861-0100
Mailing Address - Fax:
Practice Address - Street 1:2029 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7412
Practice Address - Country:US
Practice Address - Phone:610-861-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist