MEDICARE: VINA SARGENT I MA, 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	LL60254221	WA

General Provider Information

NPI Number	:	1811261852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINA SARGENT I MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1871 NW GILMAN BLVD
Second Line	:	SUITE 2
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
Second Line	:	SUITE 2
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	:	03/07/2012
Last Update Date	:	03/07/2012

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Directions to “ VINA SARGENT I MA, CCC-SLP” Practice Location

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