Provider Demographics
NPI:1871324152
Name:KUSHCH, NOELLE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:KUSHCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N LOIS AVE APT 1138
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2540
Mailing Address - Country:US
Mailing Address - Phone:813-638-1043
Mailing Address - Fax:
Practice Address - Street 1:2202 N LOIS AVE APT 1138
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2540
Practice Address - Country:US
Practice Address - Phone:813-638-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist