MEDICARE: WILLIAM COBURN

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	SP60780275	WA

General Provider Information

NPI Number	:	1942724158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM COBURN

Provider Business Mailing Address
First Line	:	2707 NISQUALLY VISTA CT NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98516-2352
Country	:	US
Telephone Number	:	360-728-5775
Fax Number	:

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	:

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

Provider Enumeration Date	:	07/29/2017
Last Update Date	:	02/07/2026

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Directions to “ WILLIAM COBURN ” Practice Location

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