Provider Demographics
NPI:1992899272
Name:KOUKA, KRISTIN L (SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:L
Last Name:KOUKA
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 1:10 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1513
Mailing Address - Country:US
Mailing Address - Phone:317-846-4279
Mailing Address - Fax:
Practice Address - Street 1:9505 E 59TH ST
Practice Address - Street 2:SUITE B1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1025
Practice Address - Country:US
Practice Address - Phone:317-542-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004115A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist