Individual
ANGELA KOUTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4602 47TH AVE, WOODSIDE, NY 11377-6123
(718) 937-0320
Mailing address
4602 47TH AVE, WOODSIDE, NY 11377-6123
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
024826
NY
Other
Enumeration date
11/30/2016
Last updated
12/02/2016
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