Individual
MRS. KRISTIN MARIE COUTURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4405 EVANS TO LOCKS RD STE C, EVANS, GA 30809-3603
(706) 854-1598
(706) 854-8136
Mailing address
244 SILVER MAPLE RD, MARTINEZ, GA 30907-1281
(706) 860-2710
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003085
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00897586B
—
GA
01
—
10038318
AMERIGROUP PROVIDER NUMBE
GA
01
—
305694
WELLCARE PROVIDER NUMBER
GA
Enumeration date
11/16/2006
Last updated
07/08/2007
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