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General NPI Number Information
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NPI Number | 1417113598
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Entity Type | Individual
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Provider Name | COURTNEY PAULINE KOHARCHICK MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 302 N JOHNSON RD MOORESVILLE
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City | MOORESVILLE
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State | IN
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Zip | 46158-5504
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Country | US
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Telephone | 317-831-9033
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Fax |
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Provider Business Mailing Address
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Address Line | 2297 SOUTHWARD DR GREENWOOD
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City | GREENWOOD
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State | IN
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Zip | 46143-3421
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Country | US
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Telephone | 574-329-2310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 46001737A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22004740A
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License Number State | IN
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