Healthcare Provider Details

I. General information

NPI: 1679897995
Provider Name (Legal Business Name): THE AUBIN APHASIA SPEECH AND LANGUAGE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MADISON AVE S STE 106
BAINBRIDGE ISLAND WA
98110-2544
US

IV. Provider business mailing address

330 MADISON AVE S STE 106
BAINBRIDGE ISLAND WA
98110-2544
US

V. Phone/Fax

Practice location:
  • Phone: 206-355-9985
  • Fax:
Mailing address:
  • Phone: 206-355-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberLL00004536
License Number StateWA

VIII. Authorized Official

Name: MS. JESSICA L AUBIN
Title or Position: LLC MANAGER
Credential: MS CCC SLP
Phone: 206-355-9985