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General NPI Number Information
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NPI Number | 1053709204
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Entity Type | Organization
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Legal Business Name | ABC SPEECH THERAPY
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 19319 7TH AVE NE STE 104
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City | POULSBO
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State | WA
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Zip | 98370-7442
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Country | US
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Telephone | 360-830-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 19319 7TH AVE NE STE 104
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City | POULSBO
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State | WA
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Zip | 98370-7442
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Country | US
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Telephone | 360-830-6757
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGAUGE PATHOLOGIST/OWNER
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Name | MRS. ROBIN COLE ROGERS
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Credential | M.S. CCC/SLP
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Telephone | 360-830-6757
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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 | 60110522
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License Number State | WA
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