Provider Demographics
NPI:1316263437
Name:KOSWATTA, ERIKA A (MED)
Entity type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:A
Last Name:KOSWATTA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39005 LOCHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5910
Mailing Address - Country:US
Mailing Address - Phone:216-990-3401
Mailing Address - Fax:440-498-1631
Practice Address - Street 1:39005 LOCHMOOR DR
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-5910
Practice Address - Country:US
Practice Address - Phone:216-990-3401
Practice Address - Fax:440-498-1631
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0014041104100000X
OH00050235225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker