Healthcare Provider Details

I. General information

NPI: 1619312212
Provider Name (Legal Business Name): MRS. BARBARA NOWICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S SPARTAN AVE
FORKS WA
98331-9028
US

IV. Provider business mailing address

411 S SPARTAN AVE
FORKS WA
98331-9028
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-6262
  • Fax: 360-374-2363
Mailing address:
  • Phone: 360-374-6262
  • Fax: 360-374-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00001756
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number248427G
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: