Provider Demographics
NPI:1407311079
Name:COUGHLIN, BARRY JOSEPH
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JOSEPH
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2802
Mailing Address - Country:US
Mailing Address - Phone:605-725-3277
Mailing Address - Fax:605-725-3277
Practice Address - Street 1:524 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2802
Practice Address - Country:US
Practice Address - Phone:605-725-3277
Practice Address - Fax:605-725-3277
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD385H237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist