Provider Demographics
NPI:1003129461
Name:MERCER ISLAND THERAPY, PLLC
Entity Type:Organization
Organization Name:MERCER ISLAND THERAPY, PLLC
Other - Org Name:NORTHWEST SPEECH THERAPY / SPOTLIGHT SOCIAL SKILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:K
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-226-8879
Mailing Address - Street 1:8015 SE 28TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2910
Mailing Address - Country:US
Mailing Address - Phone:206-226-8813
Mailing Address - Fax:630-604-9955
Practice Address - Street 1:8015 SE 28TH ST STE 309
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2910
Practice Address - Country:US
Practice Address - Phone:206-236-1294
Practice Address - Fax:206-257-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 1041C0700X
WALL00001598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty