MEDICARE: MRS. KRISTIN L KOUKA SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22004115A	IN

General Provider Information

NPI Number	:	1992899272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN L KOUKA SLP

Provider Business Mailing Address
First Line	:	10 SHERMAN DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-1513
Country	:	US
Telephone Number	:	317-846-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	9505 E 59TH ST
Second Line	:	SUITE B1
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-1025
Country	:	US
Telephone Number	:	317-542-7680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/16/2007

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