Provider Demographics
NPI:1245651553
Name:COUGHLIN, LINDA MARY (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARY
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:COUGHLIN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:100 E BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3143
Mailing Address - Country:US
Mailing Address - Phone:414-339-0554
Mailing Address - Fax:
Practice Address - Street 1:6700 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3919
Practice Address - Country:US
Practice Address - Phone:414-351-8850
Practice Address - Fax:414-351-8846
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
WI4259154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist