Provider Demographics
NPI:1083128920
Name:NORRBOM, LEAH RACHELLE (SLPA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RACHELLE
Last Name:NORRBOM
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:RACHELLE
Other - Last Name:FIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:2696 STATE ROUTE 903
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-8704
Mailing Address - Country:US
Mailing Address - Phone:509-649-4700
Mailing Address - Fax:509-649-2074
Practice Address - Street 1:2696 STATE ROUTE 903
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-8704
Practice Address - Country:US
Practice Address - Phone:509-649-4700
Practice Address - Fax:509-649-2074
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA607674892355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60767489Medicaid