Provider Demographics
NPI:1073852737
Name:COWDREY, SUSAN DOREEN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DOREEN
Last Name:COWDREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZY
Other - Middle Name:D
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:ASOTIN
Mailing Address - State:WA
Mailing Address - Zip Code:99402-0489
Mailing Address - Country:US
Mailing Address - Phone:509-243-4146
Mailing Address - Fax:
Practice Address - Street 1:314 FIRST STREET
Practice Address - Street 2:
Practice Address - City:ASOTIN
Practice Address - State:WA
Practice Address - Zip Code:99402-0489
Practice Address - Country:US
Practice Address - Phone:509-243-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60327608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist