Provider Demographics
NPI:1326781998
Name:COUGHLIN, LARA JEAN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:JEAN
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 1:10 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5216
Mailing Address - Country:US
Mailing Address - Phone:603-205-5792
Mailing Address - Fax:
Practice Address - Street 1:7 GREENLEAF WOODS DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5444
Practice Address - Country:US
Practice Address - Phone:603-205-5792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist