Provider Demographics
NPI:1033356316
Name:WONG, UMSHA M (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:UMSHA
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:UMSHA
Other - Middle Name:MOODLEY
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:7802 DOUGLAS AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9746
Mailing Address - Country:US
Mailing Address - Phone:425-396-5658
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2774
Practice Address - Fax:206-764-2672
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60063084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist