Provider Demographics
NPI:1477553030
Name:COHN, SUSAN LYNN (MAT, CCC-S)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:COHN
Suffix:
Gender:F
Credentials:MAT, CCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N.W. JUNIPER ST
Mailing Address - Street 2:#108
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-392-4965
Mailing Address - Fax:425-391-2555
Practice Address - Street 1:710 N.W. JUNIPER ST
Practice Address - Street 2:#108
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-392-4965
Practice Address - Fax:425-391-2555
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist