Provider Demographics
NPI:1063015287
Name:SPEIZER, ILAN R (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ILAN
Middle Name:R
Last Name:SPEIZER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 NE 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5823
Mailing Address - Country:US
Mailing Address - Phone:206-294-0443
Mailing Address - Fax:
Practice Address - Street 1:HAZEL WOLF K-8
Practice Address - Street 2:11530 12TH AVE NE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-9811
Practice Address - Country:US
Practice Address - Phone:206-294-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLP.LL.60600517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist