MEDICARE: SEATTLE SPEECH PATHOLOGY, PLLC

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	:	1366102527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE SPEECH PATHOLOGY, PLLC

Provider Business Mailing Address
First Line	:	300 LENORA ST # 585
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2411
Country	:	US
Telephone Number	:	206-409-3372
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 E HARRISON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-5112
Country	:	US
Telephone Number	:	206-745-2812
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	ALITA SHAW
Credential	:	M.A. CCC-SLP
Telephone Number	:	206-409-3372

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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