Healthcare Provider Details

I. General information

NPI: 1346706587
Provider Name (Legal Business Name): ANA S MAGALLANES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33303 SE 124TH ST
ISSAQUAH WA
98027-8741
US

IV. Provider business mailing address

300 S 55TH ST APT B101
RENTON WA
98055-7910
US

V. Phone/Fax

Practice location:
  • Phone: 206-799-7831
  • Fax:
Mailing address:
  • Phone: 562-293-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number61339531
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: