Healthcare Provider Details

I. General information

NPI: 1821971961
Provider Name (Legal Business Name): GEORGIE FILL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N 1ST ST STE 8
MOUNT VERNON WA
98273-2858
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:
Mailing address:
  • Phone: 360-416-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: