Healthcare Provider Details

I. General information

NPI: 1528974789
Provider Name (Legal Business Name): CAMILLE RYAN SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9576 RIDGETOP BLVD NW STE L101
SILVERDALE WA
98383-8554
US

IV. Provider business mailing address

9304 WOODWORTH AVE
GIG HARBOR WA
98332-1065
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-0007
  • Fax:
Mailing address:
  • Phone: 828-708-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number70031832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: