Individual
BETH ANN KICSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
36 TALCOTT ST, OWEGO, NY 13827-1023
(607) 687-6226
Mailing address
294 PITKIN HILL RD, JOHNSON CITY, NY 13790-4421
(607) 785-0524
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
012610-1
NY
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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