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General NPI Number Information
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NPI Number | 1003688540
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Entity Type | Organization
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Legal Business Name | PEREGRINE THERAPY, PLLC
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 16770 NE 79TH ST STE 105
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City | REDMOND
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State | WA
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Zip | 98052-4413
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Country | US
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Telephone | 425-689-8570
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Fax | 425-689-7521
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Provider Business Mailing Address
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Address Line | 16770 NE 79TH ST STE 105
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City | REDMOND
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State | WA
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Zip | 98052-4413
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Country | US
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Telephone | 425-689-8570
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Fax | 425-689-7521
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Authorized Official
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Title or Position | OWNER, SPEECH-LANGUAGE PATHOLOGIST
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Name | MR. DANIEL MILLER IV
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Credential | MS, MA, CCC-SLP
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Telephone | 765-476-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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