1497195150 NPI number — MRS. MARIYA BURROWS M.S., CCC-SLP

Table of content: MRS. MARIYA BURROWS M.S., CCC-SLP (NPI 1497195150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497195150 NPI number — MRS. MARIYA BURROWS M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURROWS
Provider First Name:
MARIYA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., 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:
LEGESSE
Provider Other First Name:
MARIYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497195150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10016 EDMONDS WAY
Provider Second Line Business Mailing Address:
STE C-230
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98020-5107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-409-9351
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10016 EDMONDS WAY
Provider Second Line Business Practice Location Address:
STE C-230
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98020-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-409-9351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2013

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 501859C . This is a "OSPI, PROFESSIONAL EDUCATION & CERTIFICATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 14058654 . This is a "ASHA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: LL60508598 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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