Healthcare Provider Details

I. General information

NPI: 1154776599
Provider Name (Legal Business Name): MARIAH CARMEN KANAKIA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAH CARMEN HOWARD

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PACIFIC AVE STE 130
EVERETT WA
98201-4188
US

IV. Provider business mailing address

9742 NE 119TH WAY APT D218
KIRKLAND WA
98034-8945
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-7352
  • Fax: 425-258-7618
Mailing address:
  • Phone: 309-453-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSI 60597418
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60712301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: