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NPI Code Detail

MEDICARE: MOIRA JEAN HETLAGE M.S. SLP

MEDICARE: MOIRA JEAN HETLAGE M.S. 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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1659617900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOIRA JEAN HETLAGE M.S. SLP
Provider Business Mailing Address
First Line : 1515 24TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98122-3008
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1515 24TH AVE
Second Line :
City : SEATTLE
State : WA
Zip : 98122-3008
Country : US
Telephone Number : 425-456-5160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2012
Last Update Date : 12/13/2012

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Directions to “ MOIRA JEAN HETLAGE M.S. SLP” Practice Location

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