Provider Demographics
NPI:1659492213
Name:COUGHLIN, PATRICIA MARY (DMIN)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARY
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 N RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1913
Mailing Address - Country:US
Mailing Address - Phone:773-764-2413
Mailing Address - Fax:773-761-5131
Practice Address - Street 1:7430 N RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1913
Practice Address - Country:US
Practice Address - Phone:773-764-2413
Practice Address - Fax:773-761-5131
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional