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General NPI Number Information
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NPI Number | 1588542922
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Entity Type | Individual
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Provider Name | MIRANDA BASILE M.ED., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 148 102ND AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98004-6197
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Country | US
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Telephone | 425-298-3979
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Fax |
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Provider Business Mailing Address
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Address Line | 6133 NE 193RD PL
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City | KENMORE
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State | WA
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Zip | 98028-3230
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Country | US
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Telephone | 702-802-9671
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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 | SLP.LL.70008239
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14510877
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License Number State | WA
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