Provider Demographics
NPI:1043418148
Name:KOUL, AMITA (MS/SLP)
Entity type:Individual
Prefix:
First Name:AMITA
Middle Name:
Last Name:KOUL
Suffix:
Gender:F
Credentials:MS/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 TABLEROCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3705
Mailing Address - Country:US
Mailing Address - Phone:917-551-0100
Mailing Address - Fax:
Practice Address - Street 1:510 S BIRMINGHAM ST
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4200
Practice Address - Country:US
Practice Address - Phone:917-551-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111770235Z00000X
FLSA 8982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist