Healthcare Provider Details

I. General information

NPI: 1003723065
Provider Name (Legal Business Name): GLADYS MUNGUIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 C ST SE
QUINCY WA
98848-1488
US

IV. Provider business mailing address

404 1ST AVE SW
QUINCY WA
98848-1201
US

V. Phone/Fax

Practice location:
  • Phone: 509-787-8950
  • Fax:
Mailing address:
  • Phone: 509-787-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA.SP.70118407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: