Healthcare Provider Details

I. General information

NPI: 1174817274
Provider Name (Legal Business Name): LAURA VANDERLINDE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

6117 N ATLANTIC ST APT 2
SPOKANE WA
99205-6274
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-5165
  • Fax: 425-656-4028
Mailing address:
  • Phone: 509-280-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1526
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60632599
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: