Healthcare Provider Details

I. General information

NPI: 1164454393
Provider Name (Legal Business Name): MARYAM SADRZADEH MS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 161ST AVE NE SUITE 203
REDMOND WA
98052-3858
US

IV. Provider business mailing address

8301 161ST AVE NE SUITE 203
REDMOND WA
98052-3858
US

V. Phone/Fax

Practice location:
  • Phone: 425-882-4347
  • Fax:
Mailing address:
  • Phone: 425-882-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number021602 SI00002745
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: