1922026905 NPI number — MRS. ERIN SIOBHAN TULLY-CLINARD MA, CCC-SLP

Table of content: MRS. ERIN SIOBHAN TULLY-CLINARD MA, CCC-SLP (NPI 1922026905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922026905 NPI number — MRS. ERIN SIOBHAN TULLY-CLINARD MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TULLY-CLINARD
Provider First Name:
ERIN
Provider Middle Name:
SIOBHAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, 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:
TULLY
Provider Other First Name:
ERIN
Provider Other Middle Name:
SIOBHAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922026905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31500 33RD PL SW APT Q103
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:
98023-5923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-508-9394
Provider Business Mailing Address Fax Number:
253-627-5004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 DIVISION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-403-4437
Provider Business Practice Location Address Fax Number:
253-627-5004
Provider Enumeration Date:
07/17/2006

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:  0000003121 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: LL00004323 , 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: 4106728 . This is a "BCBS PROVIDER ID NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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