MEDICARE: DINESH KANNADATH M.SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1285908327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINESH KANNADATH M.SC

Provider Business Mailing Address
First Line	:	1542 E LAKE SAMMAMISH PKWY NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-6639
Country	:	US
Telephone Number	:	425-868-3669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 E LAKE SAMMAMISH PKWY NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-6639
Country	:	US
Telephone Number	:	425-868-3669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2012
Last Update Date	:	03/07/2012

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Directions to “ DINESH KANNADATH M.SC” Practice Location

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