MEDICARE: MRS. MARY KATHRYN COBURN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist	LL 60390353	WA

General Provider Information

NPI Number	:	1417263526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATHRYN COBURN CCC-SLP

Provider Business Mailing Address
First Line	:	344 CLEVELAND AVE SE STE F
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3342
Country	:	US
Telephone Number	:	360-350-2220
Fax Number	:	855-814-8815

Provider Business Practice Location Address
First Line	:	344 CLEVELAND AVE SE STE F
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3342
Country	:	US
Telephone Number	:	360-350-2220
Fax Number	:	855-814-8815

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	04/29/2024

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Directions to “ MRS. MARY KATHRYN COBURN CCC-SLP” Practice Location

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