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General NPI Number Information
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NPI Number | 1639591290
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Entity Type | Organization
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Legal Business Name | NICHOLE CARUBIA SPEECH LANGUAGE PATHOLOGY LLC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 620 N WAUGH RD
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City | MOUNT VERNON
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State | WA
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Zip | 98273-9469
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Country | US
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Telephone | 360-319-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N WAUGH RD
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City | MOUNT VERNON
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State | WA
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Zip | 98273-9469
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Country | US
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Telephone | 360-319-9248
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST, OWNER
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Name | NICHOLE F CARUBIA
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Credential | MA, CCC-SLP
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Telephone | 360-319-9248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | LL00004767
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License Number State | WA
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