Provider Demographics
NPI:1649500422
Name:COUCHON, SUZANNE E (SLP-CCC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:COUCHON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 N MERIDIAN ST STE 312
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4562
Mailing Address - Country:US
Mailing Address - Phone:317-815-0778
Mailing Address - Fax:866-364-9343
Practice Address - Street 1:830 MEADOWBROOK CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2636
Practice Address - Country:US
Practice Address - Phone:317-251-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003353A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist