Provider Demographics
NPI:1194076901
Name:KOSIROG, CHRISTINE MICHELE (SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:KOSIROG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 HARVARD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2611
Practice Address - Country:US
Practice Address - Phone:785-842-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist