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NPI Code Detail

MEDICARE: MARY ELIZABETH CUSIC MS

MEDICARE: MARY ELIZABETH CUSIC MS
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 PathologistSI00004671WA

General Provider Information

NPI Number : 1740441260
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH CUSIC MS
Provider Business Mailing Address
First Line : 1871 NW GILMAN BLVD STE 2
Second Line :
City : ISSAQUAH
State : WA
Zip : 98027-8116
Country : US
Telephone Number : 425-657-0620
Fax Number :
Provider Business Practice Location Address
First Line : 1871 NW GILMAN BLVD STE 2
Second Line :
City : ISSAQUAH
State : WA
Zip : 98027-8116
Country : US
Telephone Number : 425-657-0620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2008
Last Update Date : 07/10/2013

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Directions to “ MARY ELIZABETH CUSIC MS” Practice Location

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