Healthcare Provider Details

I. General information

NPI: 1205572013
Provider Name (Legal Business Name): JASON ZOLDESSY M.ED., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E YAKIMA AVE
YAKIMA WA
98901-5407
US

IV. Provider business mailing address

PO BOX 829
KITTITAS WA
98934-0829
US

V. Phone/Fax

Practice location:
  • Phone: 509-606-8011
  • Fax:
Mailing address:
  • Phone: 509-606-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSI61256036
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: