Provider Demographics
NPI:1538461827
Name:KOURI, THERESA ANN (PHD,CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:KOURI
Suffix:
Gender:F
Credentials:PHD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CORDOBA AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6316
Mailing Address - Country:US
Mailing Address - Phone:319-266-8561
Mailing Address - Fax:
Practice Address - Street 1:312 CORDOBA AVE
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6316
Practice Address - Country:US
Practice Address - Phone:319-266-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist