Provider Demographics
NPI:1306815600
Name:COUGHLAN, ELIZABETH ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:COUGHLAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W. HAMPDEN PL
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2471
Mailing Address - Country:US
Mailing Address - Phone:303-788-7880
Mailing Address - Fax:303-788-7883
Practice Address - Street 1:401 W. HAMPDEN PL
Practice Address - Street 2:SUITE 240
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2471
Practice Address - Country:US
Practice Address - Phone:303-788-7880
Practice Address - Fax:303-788-7883
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94406367Medicaid