1689712887 NPI number — MRS. DARA J KANWISCHER SCHMECK MS CCC-SLP

Table of content: MRS. DARA J KANWISCHER SCHMECK MS CCC-SLP (NPI 1689712887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689712887 NPI number — MRS. DARA J KANWISCHER SCHMECK MS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANWISCHER SCHMECK
Provider First Name:
DARA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KANWISCHER
Provider Other First Name:
DARA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689712887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16030 BOTHELL EVERETT HWY
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
MILL CREEK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98012-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-338-9005
Provider Business Mailing Address Fax Number:
425-337-0931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16030 BOTHELL EVERETT HWY
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
MILL CREEK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98012-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-338-9005
Provider Business Practice Location Address Fax Number:
425-337-0931
Provider Enumeration Date:
02/01/2007

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:  LL00004001 , 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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