Provider Demographics
NPI:1770679227
Name:COKER, KIRSTEN L (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:COKER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LUCAS LANE
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-4021
Mailing Address - Country:US
Mailing Address - Phone:207-666-8904
Mailing Address - Fax:
Practice Address - Street 1:17 LUCAS LANE
Practice Address - Street 2:
Practice Address - City:BOWDOINHAM
Practice Address - State:ME
Practice Address - Zip Code:04008-4021
Practice Address - Country:US
Practice Address - Phone:207-666-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist