Provider Demographics
NPI:1285986661
Name:COULSON, STEPHANIE RAE
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RAE
Last Name:COULSON
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 1:6423 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1564
Mailing Address - Country:US
Mailing Address - Phone:251-661-3235
Mailing Address - Fax:
Practice Address - Street 1:2223 CARTERSVILLE HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-2270
Practice Address - Country:US
Practice Address - Phone:770-443-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist