Doctor Name: | KELLI M COTHERN |
NPI Number: | 1407980519 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SPEECH THERAPIST |
License Number: | |
Business Practice Address: | 507 E Armstrong Ave Peoria, IL - 616033201 |
Business Phone Number: | 3096861177 |
Business Fax Number: | |
Mailing Address: | 115 Heritage Dr, MACKINAW |
State: | IL |
Postal Code: | 617558996 |
Phone Number: | 2178209184 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 07/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |