Provider Demographics
NPI:1386951127
Name:COUCHMAN, AMY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COUCHMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WALLINGWOOD DR
Mailing Address - Street 2:BLDG 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6900
Mailing Address - Country:US
Mailing Address - Phone:512-327-6179
Mailing Address - Fax:512-327-1545
Practice Address - Street 1:2525 WALLINGWOOD DR
Practice Address - Street 2:BLDG 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6900
Practice Address - Country:US
Practice Address - Phone:512-327-6179
Practice Address - Fax:512-327-1545
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist