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General NPI Number Information
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NPI Number | 1992902308
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Entity Type | Individual
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Provider Name | TAMARA COULSON MS
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2200 IRONWOOD PL
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2610
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Country | US
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Telephone | 298-667-6486
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Fax |
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Provider Business Mailing Address
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Address Line | 24324 E 1ST AVE
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-9628
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Country | US
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Telephone | 509-255-5297
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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 | SLP-1241
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License Number State | ID
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