Provider Demographics
NPI:1447627369
Name:KOROSA, LUAN (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LUAN
Middle Name:
Last Name:KOROSA
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 REX LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3432
Mailing Address - Country:US
Mailing Address - Phone:330-644-9969
Mailing Address - Fax:
Practice Address - Street 1:1474 BOETTLER RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9584
Practice Address - Country:US
Practice Address - Phone:330-896-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist