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General NPI Number Information
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NPI Number | 1841154127
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Entity Type | Individual
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Provider Name | JILLIAN MASAKO MITSUDA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 34600 12TH AVE SW
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City | FEDERAL WAY
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State | WA
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Zip | 98023-7060
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Country | US
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Telephone | 253-945-3804
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Fax |
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Provider Business Mailing Address
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Address Line | 34816 1ST AVE S APT A515
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6983
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Country | US
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Telephone | 253-945-3804
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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 | 610329E
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License Number State | WA
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