Provider Demographics
NPI:1083039598
Name:CHUNG, LINDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CHUNG
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 1:18714 37TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17311 135TH AVE NE
Practice Address - Street 2:C200
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-3519
Practice Address - Country:US
Practice Address - Phone:425-486-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60441305225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics