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General NPI Number Information
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NPI Number | 1205185592
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE SIEWERT M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 700 NE 112TH ST
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City | VANCOUVER
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State | WA
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Zip | 98685-3930
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Country | US
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Telephone | 360-313-2788
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 NE 101ST. STREET
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City | VANCOUVER
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State | WA
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Zip | 98686
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Country | US
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Telephone | 360-695-6624
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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 60321527
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License Number State | WA
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