Provider Demographics
NPI:1114118791
Name:LEENHOUTS, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LEENHOUTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:MATTESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 S UNION AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1959
Mailing Address - Country:US
Mailing Address - Phone:253-759-3555
Mailing Address - Fax:253-759-2988
Practice Address - Street 1:12623 MERIDIAN E STE B1A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3475
Practice Address - Country:US
Practice Address - Phone:253-256-4620
Practice Address - Fax:253-759-2988
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00003837237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist