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General NPI Number Information
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NPI Number | 1417466343
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Entity Type | Individual
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Provider Name | LEAH MARIE KOCH MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2017
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 317 N BROAD ST
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-8763
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Country | US
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Telephone | 509-565-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 17016 E INDIANA PKWY APT C310
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City | SPOKANE VALLEY
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State | WA
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Zip | 99016-5242
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Country | US
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Telephone | 203-815-4901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | LL60792815
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License Number State | WA
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