Healthcare Provider Details

I. General information

NPI: 1043620032
Provider Name (Legal Business Name): STEPHANIE MARIE KOSKI AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARIE BAJ AUD

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 GRANDVIEW PARKWAY SUITE 530
BIRMINGHAM AL
35243
US

IV. Provider business mailing address

3686 GRANDVIEW PARKWAY SUITE 530
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-8260
  • Fax: 205-595-0843
Mailing address:
  • Phone: 205-591-8260
  • Fax: 205-595-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1146A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: