Provider Demographics
NPI:1447330154
Name:KOSTELNIK, REBECCA J (MA,CCC/A)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:KOSTELNIK
Suffix:
Gender:F
Credentials:MA,CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 HIGBEE AVE NW #200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2530
Mailing Address - Country:US
Mailing Address - Phone:330-492-2844
Mailing Address - Fax:330-492-0840
Practice Address - Street 1:4912 HIGBEE AVE NW #200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2530
Practice Address - Country:US
Practice Address - Phone:330-492-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA 00555231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist