Provider Demographics
NPI:1083078893
Name:LIAO, SHU-SHENG (SLP)
Entity Type:Individual
Prefix:MR
First Name:SHU-SHENG
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21910 24TH AVE SE UNIT B
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-5113
Mailing Address - Country:US
Mailing Address - Phone:425-231-1779
Mailing Address - Fax:
Practice Address - Street 1:21910 24TH AVE SE UNIT B
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-5113
Practice Address - Country:US
Practice Address - Phone:425-231-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND 2016159235Z00000X
WALL60959426235Z00000X
SLP25171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist