Provider Demographics
NPI:1467663112
Name:COUGHLIN, KRISTINE ASH
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ASH
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:R
Other - Last Name:ASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-0301
Mailing Address - Country:US
Mailing Address - Phone:970-209-0634
Mailing Address - Fax:970-325-4407
Practice Address - Street 1:816 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5765
Practice Address - Country:US
Practice Address - Phone:970-209-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO179231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC533038Medicare ID - Type Unspecified