Provider Demographics
NPI:1417223793
Name:COUGHENOUR, CARRIE LARIE (MED, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LARIE
Last Name:COUGHENOUR
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 CAPON ST
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22657-1175
Mailing Address - Country:US
Mailing Address - Phone:540-465-5003
Mailing Address - Fax:
Practice Address - Street 1:776 CAPON ST
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-1175
Practice Address - Country:US
Practice Address - Phone:540-465-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist