Provider Demographics
NPI:1528184546
Name:COULSON, JOYCE A
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:COULSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:18475 HIGHWAY 11
Mailing Address - City:MENDON
Mailing Address - State:MO
Mailing Address - Zip Code:64660-0043
Mailing Address - Country:US
Mailing Address - Phone:660-272-3201
Mailing Address - Fax:660-272-3419
Practice Address - Street 1:NORTHWESTERN R-I SCHOOLS
Practice Address - Street 2:18475 HIGHWAY 11
Practice Address - City:MENDON
Practice Address - State:MO
Practice Address - Zip Code:64660-0043
Practice Address - Country:US
Practice Address - Phone:660-272-3201
Practice Address - Fax:660-272-3419
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467644217Medicaid