=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275829012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NW SPEECH THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2011
-----------------------------------------------------
Last Update Date | 06/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4305 SE 166TH CT
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-512-9355
-----------------------------------------------------
Fax | 888-844-0883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4305 SE 166TH CT
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-512-9355
-----------------------------------------------------
Fax | 888-844-0883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST/OWNER
-----------------------------------------------------
Name | JENNIFER ROBIN GETCH
-----------------------------------------------------
Credential | MA.CCC-SLP
-----------------------------------------------------
Telephone | 503-512-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | LL00004082
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------