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General NPI Number Information
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NPI Number | 1194104620
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Entity Type | Individual
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Provider Name | MALLORY PUENTES MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2015
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 1031 SW 130TH ST
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City | BURIEN
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State | WA
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Zip | 98146-3132
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Country | US
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Telephone | 206-242-3213
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Fax |
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Provider Business Mailing Address
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Address Line | 2516 14TH AVE W APT 301
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City | SEATTLE
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State | WA
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Zip | 98119-2108
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Country | US
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Telephone | 714-604-6576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LL 60482892
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License Number State | WA
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