Provider Demographics
NPI:1063292910
Name:COUGHLIN, MAURA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:MAURA
Middle Name:ELIZABETH
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 CROSS PARK LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8299
Mailing Address - Country:US
Mailing Address - Phone:978-551-6667
Mailing Address - Fax:
Practice Address - Street 1:544 CROSS PARK LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8299
Practice Address - Country:US
Practice Address - Phone:978-551-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist