Provider Demographics
NPI:1043913312
Name:EIERDAM, NOAH J (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:J
Last Name:EIERDAM
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:
Other - Last Name:EIERDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2727 E 53RD AVE APT C302
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7993
Mailing Address - Country:US
Mailing Address - Phone:509-828-9121
Mailing Address - Fax:
Practice Address - Street 1:3737 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5036
Practice Address - Country:US
Practice Address - Phone:509-354-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist