Provider Demographics
NPI:1588089742
Name:COULLES, LINDA (SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:COULLES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 S DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2104
Mailing Address - Country:US
Mailing Address - Phone:937-859-5121
Mailing Address - Fax:937-643-5460
Practice Address - Street 1:4100 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-2104
Practice Address - Country:US
Practice Address - Phone:937-859-5121
Practice Address - Fax:937-643-5460
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 0320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist