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General NPI Number Information
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NPI Number | 1942743695
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Entity Type | Organization
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Legal Business Name | A COMMUNICATION SPACE PLLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 4204 S ALASKA ST
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City | TACOMA
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State | WA
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Zip | 98418-1626
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Country | US
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Telephone | 253-534-5665
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Fax |
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Provider Business Mailing Address
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Address Line | 4204 S ALASKA ST
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City | TACOMA
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State | WA
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Zip | 98418-1626
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Country | US
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Telephone | 253-534-5665
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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 | KRISTEN ELIZABETH BAILEY
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Credential | MA CCC-SLP
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Telephone | 253-534-5665
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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 | 604059477
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License Number State | WA
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