Provider Demographics
NPI:1124273016
Name:COUGHLIN, SANDRA DALE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DALE
Last Name:COUGHLIN
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 1:30 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1007
Mailing Address - Country:US
Mailing Address - Phone:516-314-7301
Mailing Address - Fax:
Practice Address - Street 1:30 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-1007
Practice Address - Country:US
Practice Address - Phone:516-314-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011646-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist