Healthcare Provider Details

I. General information

NPI: 1649888686
Provider Name (Legal Business Name): FRANCES BUENO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 SE KENT KANGLEY RD
KENT WA
98030-7108
US

IV. Provider business mailing address

10811 SE KENT KANGLEY RD
KENT WA
98030-7108
US

V. Phone/Fax

Practice location:
  • Phone: 253-854-5660
  • Fax: 253-854-7025
Mailing address:
  • Phone: 253-854-5660
  • Fax: 253-854-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL61089567
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: