Provider Demographics
NPI:1083120927
Name:SIMKIN-MAASS, MARY MANCHESTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MANCHESTER
Last Name:SIMKIN-MAASS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:S
Other - Last Name:MAASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6737 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1981 NE COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-543-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LL60810349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA09129417OtherAMERICAN SPEECH-LANGUAGE AND HEARING ASSOCIATION (ASHA)
WALL60810349OtherWA STATE DEPT OF HEALTH LICENSE