Provider Demographics
NPI:1699753715
Name:COEN, KATHERINE S (SLP)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:S
Last Name:COEN
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 1:2916 BUCKLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7539
Mailing Address - Country:US
Mailing Address - Phone:704-604-8494
Mailing Address - Fax:704-921-0070
Practice Address - Street 1:716 MARSH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1851
Practice Address - Country:US
Practice Address - Phone:704-522-9912
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6235OtherSLP LICENSE NUMBER
NC7412041Medicaid