Healthcare Provider Details

I. General information

NPI: 1447085170
Provider Name (Legal Business Name): ANNELIESE M HELLNER MA, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNELIESE M TACHERON

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

IV. Provider business mailing address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

V. Phone/Fax

Practice location:
  • Phone: 360-416-7570
  • Fax: 360-416-7580
Mailing address:
  • Phone: 360-416-7570
  • Fax: 360-416-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSI61603282
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: