1568248342 NPI number — LAKE STEVENS SPEECH LANGUAGE AND AAC, PLLC

Table of content: (NPI 1568248342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568248342 NPI number — LAKE STEVENS SPEECH LANGUAGE AND AAC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE STEVENS SPEECH LANGUAGE AND AAC, PLLC
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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1568248342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 131ST DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE STEVENS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98258-9783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-870-9147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 124TH AVE NE UNIT 997
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-592-3601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DAMBOISE
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official Telephone Number:
360-870-9147

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)





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