MEDICARE: KAYLE SHULENBERGER M.A. CCC-SLP

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	LL00003029	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SH2269	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1508858671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLE SHULENBERGER M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 819
Second Line	:
City	:	ORTING
State	:	WA
Zip	:	98360-0819
Country	:	US
Telephone Number	:	360-893-6576
Fax Number	:	360-893-6506

Provider Business Practice Location Address
First Line	:	2301 NE BLAKELEY ST
Second Line	:	SUITE 101A
City	:	SEATTLE
State	:	WA
Zip	:	98105-3278
Country	:	US
Telephone Number	:	206-522-6830
Fax Number	:	206-522-5929

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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Directions to “ KAYLE SHULENBERGER M.A. CCC-SLP” Practice Location

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