1508829052 NPI number — CHILDRENS COMMUNICATION CORNER INC

Table of content: (NPI 1508829052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508829052 NPI number — CHILDRENS COMMUNICATION CORNER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS COMMUNICATION CORNER INC
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:
6
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:
1508829052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4115 UNIVERSITY WAY NE,
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-299-1780
Provider Business Mailing Address Fax Number:
206-524-9836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2366 EASTLAKE AVE E
Provider Second Line Business Practice Location Address:
#307
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-371-9133
Provider Business Practice Location Address Fax Number:
206-524-9836
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
SHANA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/SLP
Authorized Official Telephone Number:
206-299-1780

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  LL00003194 , 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: 7115272 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6704KE . This is a "REGENCE BLUE SHIELD OF WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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