Provider Demographics
NPI:1811468572
Name:KOPYSTANSKI, KATHERINE A (MS)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:KOPYSTANSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:KOPYSTANSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:4703 W 52ND AVE UNIT 506
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-4071
Mailing Address - Country:US
Mailing Address - Phone:561-716-9804
Mailing Address - Fax:
Practice Address - Street 1:8 SCIENCE PARK RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7169
Practice Address - Country:US
Practice Address - Phone:207-761-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist