MEDICARE: KATHRYN ANNE TWEEDIE CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL61600924	WA

General Provider Information

NPI Number	:	1588436448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANNE TWEEDIE CCC-SLP

Provider Business Mailing Address
First Line	:	BOX 357921 IHCD CD-205
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:	206-897-1801
Fax Number	:

Provider Business Practice Location Address
First Line	:	BOX 357921 IHCD CD-205
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-7709
Country	:	US
Telephone Number	:	206-897-1801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/10/2024

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Directions to “ KATHRYN ANNE TWEEDIE CCC-SLP” Practice Location

Language	Start Address	Practice Location

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