Individual provider Active NPI

Katie Kozulla, CFY-SLP

  • Speech-Language Pathologist
  • Morgantown, WV
National Provider Identifier
1194177659
Registry record updated Jul 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
0665 Issued in WV
Practice address
161 Bakers Ridge Rd
Morgantown, WV 26508-1459
Phone
(304) 285-0692
NPI assigned
Jul 8, 2016
Last updated
Jul 8, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 0665 WV Primary

Addresses

Primary practice location

161 Bakers Ridge Rd
Morgantown, WV 26508-1459

Mailing address

161 Bakers Ridge Rd
Morgantown, WV 26508-1459
Phone (304) 285-0692

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210506002601 NY Practitioner - Qualified Speech Language Pathologist 5395154165 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
027490NYMDAdolescent Medicine (Family Medicine) Physician
0665WVMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ats Rehab OT & PT & SLP PLLC Speech-Language Pathologist CurrentSince Jan 3, 2023 Accepting new patients

Locations

1105 E County Line Rd
Ste 213
Lakewood, NJ 08701

10825 Horace Harding Expy
Flushing, NY 11368
Phone (516) 216-4108

274 W Broadway
Long Beach, NY 11561
Phone (516) 431-1400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467936000000",
    "number": "1194177659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 BAKERS RIDGE RD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265081459",
            "telephone_number": "304-285-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 BAKERS RIDGE RD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265081459",
            "telephone_number": "304-285-0692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZULLA",
        "first_name": "KATIE",
        "credential": "CFY-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-08",
        "last_updated": "2016-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "0665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.