MEDICARE: MRS. ANNALISA ROY M.A., 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	LL 60431524	WA

General Provider Information

NPI Number	:	1861816001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNALISA ROY M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1407 BOALCH AVE NW
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-7994
Country	:	US
Telephone Number	:	425-888-2777
Fax Number	:	425-888-3348

Provider Business Practice Location Address
First Line	:	209 MAIN AVE S STE 111
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8139
Country	:	US
Telephone Number	:	425-888-3347
Fax Number	:

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

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	02/07/2014

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