Healthcare Provider Details

I. General information

NPI: 1700923315
Provider Name (Legal Business Name): ANN K VIVIANO MS MA OT SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 15TH AVE SE #100
PUYALLUP WA
98372-3709
US

IV. Provider business mailing address

915 118TH AVE SE STE 110
BELLEVUE WA
98005-3875
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-5200
  • Fax: 253-697-5145
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00003579
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: