Healthcare Provider Details

I. General information

NPI: 1326418310
Provider Name (Legal Business Name): CIRCLE CREEK THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 AUBURN WAY N
AUBURN WA
98002-4109
US

IV. Provider business mailing address

1314 AUBURN WAY N
AUBURN WA
98002-4109
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-3405
  • Fax: 253-426-3096
Mailing address:
  • Phone: 253-237-3405
  • Fax: 253-426-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number603544948
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNI D DOHERTY
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 253-237-3405