Individual
JANELLE WILDER COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-5104
Mailing address
PO BOX 64260, BALTIMORE, MD 21264-4260
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
03940
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
406137300
—
MD
Enumeration date
05/27/2006
Last updated
07/31/2015
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