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NPI Code Detail

MEDICARE: MRS. COURTNI DAWN DOHERTY MS, CCC-SLP

MEDICARE: MRS. COURTNI DAWN DOHERTY MS, 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
1235Z00000XSpeech-Language PathologistLL60578339WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760851778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COURTNI DAWN DOHERTY MS, CCC-SLP
Provider Business Mailing Address
First Line : 1314 AUBURN WAY N
Second Line :
City : AUBURN
State : WA
Zip : 98002-4109
Country : US
Telephone Number : 253-237-3405
Fax Number : 253-679-0488
Provider Business Practice Location Address
First Line : 1314 AUBURN WAY N
Second Line :
City : AUBURN
State : WA
Zip : 98002-4109
Country : US
Telephone Number : 253-237-3405
Fax Number : 253-679-0488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2015
Last Update Date : 01/28/2025

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