Provider Demographics
NPI:1962692921
Name:CAHOON, SUSAN DENISE (CCCSLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:CAHOON
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4771 WESTWIND AVE.
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3079
Mailing Address - Country:US
Mailing Address - Phone:360-883-2538
Mailing Address - Fax:
Practice Address - Street 1:4771 WESTWIND AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3079
Practice Address - Country:US
Practice Address - Phone:360-883-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM343033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist