Provider Demographics
NPI:1205481249
Name:DE KOEKKOEK, TRICIA BETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:BETH
Last Name:DE KOEKKOEK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11308 MARTY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2640
Mailing Address - Country:US
Mailing Address - Phone:913-663-4927
Mailing Address - Fax:
Practice Address - Street 1:11308 MARTY ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2640
Practice Address - Country:US
Practice Address - Phone:913-663-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist