MEDICARE: YEKATERINA VINOKUROVA 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

General Provider Information

NPI Number	:	1700357498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEKATERINA VINOKUROVA SLP

Provider Business Mailing Address
First Line	:	7683 SE 27TH ST # 127
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2804
Country	:	US
Telephone Number	:	973-224-4238
Fax Number	:

Provider Business Practice Location Address
First Line	:	7683 SE 27TH ST # 127
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2804
Country	:	US
Telephone Number	:	973-224-4238
Fax Number	:

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

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/18/2018

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Directions to “ YEKATERINA VINOKUROVA SLP” Practice Location

Language	Start Address	Practice Location

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