Provider Demographics
NPI:1659714277
Name:BECKER, KATHLEEN JOHNSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JOHNSON
Last Name:BECKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 E FAIRHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1918
Mailing Address - Country:US
Mailing Address - Phone:360-757-3311
Mailing Address - Fax:360-755-9709
Practice Address - Street 1:17145 COOK RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:WA
Practice Address - Zip Code:98232-9797
Practice Address - Country:US
Practice Address - Phone:360-757-3352
Practice Address - Fax:360-757-2503
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60328968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist