Healthcare Provider Details

I. General information

NPI: 1710539176
Provider Name (Legal Business Name): GARRETT WILKES CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 112TH AVE NE STE 260E
BELLEVUE WA
98004-2937
US

IV. Provider business mailing address

7577 OLD REDMOND RD APT 5
REDMOND WA
98052-6858
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-2906
  • Fax: 509-821-9219
Mailing address:
  • Phone: 417-576-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number60971878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: