=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518619261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARLEY MISKIMENS MS, CCC- SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2022
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2239 TACKETTS MILL DR STE K
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-3026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-491-1044
-----------------------------------------------------
Fax | 703-491-2044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12503 NE 70TH CIR
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98682-4886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 61258606
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------