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General NPI Number Information
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NPI Number | 1396081790
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Entity Type | Individual
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Provider Name | SUSAN NELSON REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 2405 S 300TH ST
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4225
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Country | US
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Telephone | 253-945-4413
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 S 259TH PL
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City | DES MOINES
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State | WA
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Zip | 98198-8917
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Country | US
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Telephone | 206-212-6674
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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 | 60091397
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License Number State | WA
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