Provider Demographics
NPI:1437223989
Name:KOEHLER, MARGOT ALEXANDRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:ALEXANDRA
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3001 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 N 24TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-6607
Practice Address - Country:US
Practice Address - Phone:253-686-4725
Practice Address - Fax:866-853-0747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8344962Medicaid