Provider Demographics
NPI:1912392309
Name:COCO, SUSANNA LAURA COTTON (PHD)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:LAURA COTTON
Last Name:COCO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 5TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3132
Practice Address - Country:US
Practice Address - Phone:206-909-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
WAPY60724887103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool