Provider Demographics
NPI:1760482624
Name:COOPER, DEBORAH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MCCLUSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 17TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5787
Mailing Address - Country:US
Mailing Address - Phone:206-353-8330
Mailing Address - Fax:
Practice Address - Street 1:166 UNIT B 17TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-353-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8337917Medicaid
WA3089COOtherREGENCE BLUE SHIELD
WA0172058OtherLABOR AND INDUSTRIES