1982940250 NPI number — MRS. KAREN ROSE EADIE WA STATE SLP LICENSE

Table of content: MRS. KAREN ROSE EADIE WA STATE SLP LICENSE (NPI 1982940250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982940250 NPI number — MRS. KAREN ROSE EADIE WA STATE SLP LICENSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EADIE
Provider First Name:
KAREN
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WA STATE SLP LICENSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
KAREN
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.C.C.-SLP FROM ASHA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982940250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 ELLIOTT AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-663-7117
Provider Business Mailing Address Fax Number:
509-662-9227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 ELLIOTT AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-663-7117
Provider Business Practice Location Address Fax Number:
509-662-9227
Provider Enumeration Date:
12/14/2012

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:  LL 00001596 , 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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