Provider Demographics
NPI:1417466343
Name:KOCH, LEAH MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:KOCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17016 E INDIANA PKWY APT C310
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5242
Mailing Address - Country:US
Mailing Address - Phone:203-815-4901
Mailing Address - Fax:
Practice Address - Street 1:317 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8763
Practice Address - Country:US
Practice Address - Phone:509-565-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60792815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist