Healthcare Provider Details

I. General information

NPI: 1861326332
Provider Name (Legal Business Name): ELLIE BUNKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 SW MCFADDEN AVE
CHEHALIS WA
98532-4709
US

IV. Provider business mailing address

1336 SW MCFADDEN AVE
CHEHALIS WA
98532-4709
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-0086
  • Fax: 360-799-5052
Mailing address:
  • Phone: 360-736-0086
  • Fax: 360-799-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPI.SI.70131045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: