Healthcare Provider Details

I. General information

NPI: 1932039807
Provider Name (Legal Business Name): MARYAM GHASSEMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

IV. Provider business mailing address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-7710
  • Fax:
Mailing address:
  • Phone: 425-486-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPI.SI.70004287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: