MEDICARE: KRISTA KOSCIK M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	117669	TX
2	235Z00000X	Speech-Language Pathologist	30858	CA
3	235Z00000X	Speech-Language Pathologist	SA13686	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14054738	OTHER		AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION

General Provider Information

NPI Number	:	1285025692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA KOSCIK M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1400 VILLAGE SQUARE BLVD # 3-82212
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	352-857-6125
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 BLUE QUILL LN
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-5012
Country	:	US
Telephone Number	:	352-857-6125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2015
Last Update Date	:	07/29/2024

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Directions to “ KRISTA KOSCIK M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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