Provider Demographics
NPI:1013035229
Name:LAM, VIVIAN WAI WAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:WAI WAN
Last Name:LAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 WESTLAKE AVE N
Mailing Address - Street 2:STE. 105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2779
Mailing Address - Country:US
Mailing Address - Phone:206-633-6039
Mailing Address - Fax:206-633-6061
Practice Address - Street 1:1836 WESTLAKE AVE N
Practice Address - Street 2:STE. 105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-2779
Practice Address - Country:US
Practice Address - Phone:206-633-6039
Practice Address - Fax:206-633-6061
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002370235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist