Provider Demographics
NPI:1073857926
Name:GALLAGHER, JANNA MICHELLE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:MICHELLE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 YALE AVE E
Mailing Address - Street 2:#302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3250
Mailing Address - Country:US
Mailing Address - Phone:949-735-4275
Mailing Address - Fax:
Practice Address - Street 1:18504 BOTHELL WAY NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1927
Practice Address - Country:US
Practice Address - Phone:425-481-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60312291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist