1023266723 NPI number — KALLI CHRISTINE GOODWIN SLP

Table of content: KALLI CHRISTINE GOODWIN SLP (NPI 1023266723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023266723 NPI number — KALLI CHRISTINE GOODWIN SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOODWIN
Provider First Name:
KALLI
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOLLENBACHER
Provider Other First Name:
KALLI
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023266723
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 BOYER AVE E
Provider Second Line Business Mailing Address:
BOYER CHILDREN'S CLINIC
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98112-2922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-325-8477
Provider Business Mailing Address Fax Number:
206-323-1385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 BOYER AVE E
Provider Second Line Business Practice Location Address:
BOYER CHILDREN'S CLINIC
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-2922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-325-8477
Provider Business Practice Location Address Fax Number:
206-323-1385
Provider Enumeration Date:
09/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  LL 60032987 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)