Healthcare Provider Details

I. General information

NPI: 1871403576
Provider Name (Legal Business Name): KIRA R MINTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 SE BARRINGTON DRIVE STE 203
OAK HARBOR WA
98277
US

IV. Provider business mailing address

380 SE BARRINGTON DRIVE, OAK HARBOR, WA 98277
OAK HARBOR WA
98277-8959
US

V. Phone/Fax

Practice location:
  • Phone: 509-321-7589
  • Fax:
Mailing address:
  • Phone: 561-339-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSLPI.SI.70183210
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: