Healthcare Provider Details

I. General information

NPI: 1003059767
Provider Name (Legal Business Name): ALL ABOUT SPEECH, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 50TH STREET CT NW SUITE 101 BUILDING A
GIG HARBOR WA
98335-8556
US

IV. Provider business mailing address

3110 JUDSON ST
GIG HARBOR WA
98335-1254
US

V. Phone/Fax

Practice location:
  • Phone: 504-606-6140
  • Fax:
Mailing address:
  • Phone: 504-606-6140
  • Fax: 188-857-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberLL00004290
License Number StateWA

VIII. Authorized Official

Name: MS. JUNETTE HOPE MCGOUGIN
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MCD, CCC-SLP
Phone: 504-606-6140