Healthcare Provider Details

I. General information

NPI: 1033305446
Provider Name (Legal Business Name): MELISSA D MAMIYA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20818 44TH AVE W # 270P
LYNNWOOD WA
98036-7709
US

IV. Provider business mailing address

20818 44TH AVE W # 270P
LYNNWOOD WA
98036-7709
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-2716
  • Fax:
Mailing address:
  • Phone: 425-672-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLL00004668
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: