Healthcare Provider Details

I. General information

NPI: 1790814804
Provider Name (Legal Business Name): NOLA A MARRINER PHD LACST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 FACTORIA BLVD SE SUITE 300
BELLEVUE WA
98006
US

IV. Provider business mailing address

PO BOX 82593
KENMORE WA
98028
US

V. Phone/Fax

Practice location:
  • Phone: 425-746-2209
  • Fax: 425-484-4430
Mailing address:
  • Phone: 425-398-9901
  • Fax: 206-260-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00002108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: