Carissa Kostan

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

130 Fowler LN
Portage, PA 15946-7112

Phone

(814) 736-9890

NPI assigned

Sep 2, 2015

Last updated

Sep 2, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1441152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441152000000",
    "number": "1821466269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 FOWLER LN",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159467112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 FOWLER LN",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159467112",
            "telephone_number": "814-736-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTAN",
        "first_name": "CARISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-02",
        "last_updated": "2015-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marcie A. Kovalsky, MS, CCC-SLP
• Kaitlyn Long, OTR/L
• Joshua Thomas Madison, PT
• Mainline CPL, LLC (Mainline Pharmacy Portage)
• Chelsea Lyn Maloskey, M.S., CCC-SLP

• Speech-Language Pathologist in Portage, PA
• Providers in Portage, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.