MEDICARE: JAVAMAN PS

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	:	1730886466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVAMAN PS

Provider Business Mailing Address
First Line	:	2075 BARKLEY BLVD STE 200
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-6696
Country	:	US
Telephone Number	:	360-733-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	381 W HORTON RD
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-7740
Country	:	US
Telephone Number	:	360-733-4008
Fax Number	:	360-733-4064

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC D SHORT-MILLER
Credential	:
Telephone Number	:	360-733-4008

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	09/05/2023

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Directions to “JAVAMAN PS ” Practice Location

Language	Start Address	Practice Location

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