Provider Demographics
NPI:1093097461
Name:SHIMABUKU, JAMIE LEIALOHA (MA, CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LEIALOHA
Last Name:SHIMABUKU
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22443 SE 240TH ST
Mailing Address - Street 2:B101
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:425-358-7160
Mailing Address - Fax:425-358-7159
Practice Address - Street 1:22443 SE 240TH ST
Practice Address - Street 2:B101
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-358-7160
Practice Address - Fax:425-358-7159
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60223112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist