Provider Demographics
NPI:1194217711
Name:COUGHLIN, NICOLE DIANA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DIANA
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 LEANDO DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-8755
Mailing Address - Country:US
Mailing Address - Phone:781-346-1978
Mailing Address - Fax:
Practice Address - Street 1:7129 LEANDO DR
Practice Address - Street 2:
Practice Address - City:WILLOW SPRING
Practice Address - State:NC
Practice Address - Zip Code:27592-8755
Practice Address - Country:US
Practice Address - Phone:781-346-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist