1538410774 NPI number — MS. BARBARA COLLEEN MENDEZ MS SLP CCC

Table of content: MS. BARBARA COLLEEN MENDEZ MS SLP CCC (NPI 1538410774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538410774 NPI number — MS. BARBARA COLLEEN MENDEZ MS SLP CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDEZ
Provider First Name:
BARBARA
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS SLP CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538410774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21303 SE 270TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98038-6112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-432-8587
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12033 SE 256TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030-6503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-373-7028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2012

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 , 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)





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