MEDICARE: CARALEE LYDIA WIRTH B.A., M.S., 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	LL 60269096	WA

General Provider Information

NPI Number	:	1831447622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARALEE LYDIA WIRTH B.A., M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1629 93RD DR SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-3759
Country	:	US
Telephone Number	:	425-610-6160
Fax Number	:	425-666-2005

Provider Business Practice Location Address
First Line	:	1629 93RD DR SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-3759
Country	:	US
Telephone Number	:	425-610-6160
Fax Number	:	425-666-2005

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	01/14/2026

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