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General NPI Number Information
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NPI Number | 1215594320
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Entity Type | Organization
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Legal Business Name | KIDSTALK THERAPY, LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 205 15TH AVE SW STE B
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City | PUYALLUP
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State | WA
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Zip | 98371-7873
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Country | US
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Telephone | 253-347-2180
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Fax | 253-498-0000
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Provider Business Mailing Address
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Address Line | 205 15TH AVE SW STE B
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City | PUYALLUP
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State | WA
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Zip | 98371-7873
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Country | US
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Telephone | 253-347-2180
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Fax | 253-498-0000
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Authorized Official
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Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. TAWNI L MILLER
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Credential | M.ED., CCC-SLP
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Telephone | 253-347-2180
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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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