Provider Demographics
NPI:1922571504
Name:COTHERMAN, JON (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:COTHERMAN
Suffix:
Gender:M
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 1:492 W MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1122
Mailing Address - Country:US
Mailing Address - Phone:317-642-6058
Mailing Address - Fax:
Practice Address - Street 1:1411 W COUNTY LINE RD STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-5250
Practice Address - Country:US
Practice Address - Phone:317-642-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003178A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist