1720400849 NPI number — MS. KUANGCHIEH RADFORD M.S., CCC-SLP

Table of content: MS. KUANGCHIEH RADFORD M.S., CCC-SLP (NPI 1720400849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720400849 NPI number — MS. KUANGCHIEH RADFORD M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADFORD
Provider First Name:
KUANGCHIEH
Provider Middle Name:
Provider Name Prefix Text:
MS.
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:
RADFORD
Provider Other First Name:
KC
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720400849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33330 8TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003-6325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-945-2086
Provider Business Mailing Address Fax Number:
253-945-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4248 S 288TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-945-5235
Provider Business Practice Location Address Fax Number:
253-945-2177
Provider Enumeration Date:
01/08/2014

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:  LL60357733 , 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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