Provider Demographics
NPI:1417113598
Name:KOHARCHICK, COURTNEY PAULINE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:PAULINE
Last Name:KOHARCHICK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:PIENNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2297 SOUTHWARD DR
Mailing Address - Street 2:GREENWOOD
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3421
Mailing Address - Country:US
Mailing Address - Phone:574-329-2310
Mailing Address - Fax:
Practice Address - Street 1:302 N JOHNSON RD
Practice Address - Street 2:MOORESVILLE
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-5504
Practice Address - Country:US
Practice Address - Phone:317-831-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001737A235Z00000X
IN22004740A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist