Healthcare Provider Details

I. General information

NPI: 1639303696
Provider Name (Legal Business Name): KATHRYN COYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY COYLE

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

IV. Provider business mailing address

310 N GRANDVIEW AVE
DUBUQUE IA
52001-6388
US

V. Phone/Fax

Practice location:
  • Phone: 563-588-0506
  • Fax:
Mailing address:
  • Phone: 563-588-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number00097
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: