Provider Demographics
NPI:1083781314
Name:MOUTACHOUIK, DANA (MED, CCC-SLP ATP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MOUTACHOUIK
Suffix:
Gender:F
Credentials:MED, CCC-SLP ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8922 ZABEL WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1553
Mailing Address - Country:US
Mailing Address - Phone:502-231-2270
Mailing Address - Fax:502-231-2270
Practice Address - Street 1:8922 ZABEL WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1553
Practice Address - Country:US
Practice Address - Phone:502-299-4926
Practice Address - Fax:502-231-2270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist