Provider Demographics
NPI:1972086619
Name:COUCH, CHRISTIE BETH (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:BETH
Last Name:COUCH
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-2142
Mailing Address - Country:US
Mailing Address - Phone:870-892-4573
Mailing Address - Fax:870-892-8857
Practice Address - Street 1:1707 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-2142
Practice Address - Country:US
Practice Address - Phone:870-219-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist