Healthcare Provider Details

I. General information

NPI: 1437022357
Provider Name (Legal Business Name): ZIRU BOLEN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13413 NE LEROY HAGEN MEMORIAL DR
VANCOUVER WA
98684-5967
US

IV. Provider business mailing address

1441 NE 136TH AVE APT 12
VANCOUVER WA
98684-5974
US

V. Phone/Fax

Practice location:
  • Phone: 360-604-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL61666644
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: