Provider Demographics
NPI:1104058759
Name:COULTER, KRISTEN HAHN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:HAHN
Last Name:COULTER
Suffix:
Gender:F
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 1:109 W GRUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1411
Mailing Address - Country:US
Mailing Address - Phone:859-619-5291
Mailing Address - Fax:
Practice Address - Street 1:109 W GRUNDY AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1411
Practice Address - Country:US
Practice Address - Phone:859-619-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY09-077235Z00000X
KY3881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist