=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003415357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE SPEECH THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2020
-----------------------------------------------------
Last Update Date | 10/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16415 134TH ST NW
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98329-6631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-265-0733
-----------------------------------------------------
Fax | 253-265-0733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16415 134TH ST NW
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98329-6631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-265-0733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SLPE
-----------------------------------------------------
Name | MRS. ASHLEY NICOLE BLUE
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 253-265-0733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------