Doctor Name: | JENIFER COULSTON |
NPI Number: | 1023347424 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP-CCC |
License Number: | SP12798 |
Business Practice Address: | 6400 Laurel Canyon Blvd Ste 400 N Hollywood, CA - 916061564 |
Business Phone Number: | 8187630136 |
Business Fax Number: | 8187633838 |
Mailing Address: | 24 Pisano St, LADERA RANCH |
State: | CA |
Postal Code: | 926941530 |
Phone Number: | 9493647133 |
Fax Number: | |
NPI Enumeration Date: | 12/14/2009 |
NPI Last Update Date: | 12/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP12798 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |