Healthcare Provider Details

I. General information

NPI: 1457186553
Provider Name (Legal Business Name): MS. KATERYNA KOSTENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S CHILLICOTHE RD STE 206
AURORA OH
44202-8832
US

IV. Provider business mailing address

1555 MAYFAIR BLVD APT 2
MAYFIELD HEIGHTS OH
44124-3038
US

V. Phone/Fax

Practice location:
  • Phone: 440-846-0862
  • Fax:
Mailing address:
  • Phone: 216-410-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: