Provider Demographics
NPI:1346628369
Name:DE COUTO, CHIARA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHIARA
Middle Name:
Last Name:DE COUTO
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 1:450 DOMINO LN APT G10
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4323
Mailing Address - Country:US
Mailing Address - Phone:215-499-6187
Mailing Address - Fax:
Practice Address - Street 1:85 N MALIN RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1928
Practice Address - Country:US
Practice Address - Phone:484-423-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist