1003059767 NPI number — ALL ABOUT SPEECH, CORP

Table of content: (NPI 1003059767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003059767 NPI number — ALL ABOUT SPEECH, CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL ABOUT SPEECH, CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1003059767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3110 JUDSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-606-6140
Provider Business Mailing Address Fax Number:
188-857-1785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3206 50TH STREET CT NW
Provider Second Line Business Practice Location Address:
SUITE 101 BUILDING A
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-8556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-606-6140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCGOUGIN
Authorized Official First Name:
JUNETTE
Authorized Official Middle Name:
HOPE
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
504-606-6140

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X , with the licence number:  LL00004290 , 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)

  • Identifier: LL00004290 . This is a "WASHINGTON STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".