Healthcare Provider Details

I. General information

NPI: 1437508363
Provider Name (Legal Business Name): KIM WRONKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 05/18/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 YALE AVE N # 201
SEATTLE WA
98109-5532
US

IV. Provider business mailing address

508 YALE AVE N # 201
SEATTLE WA
98109-5532
US

V. Phone/Fax

Practice location:
  • Phone: 573-578-4954
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number60947757
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: