Provider Demographics
NPI:1093097503
Name:CHILDREN'S COMMUNICATION CORNER
Entity Type:Organization
Organization Name:CHILDREN'S COMMUNICATION CORNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CERTIFIED SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:206-299-1780
Mailing Address - Street 1:4115 UNIVERSITY WAY NE
Mailing Address - Street 2:STE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-299-1780
Mailing Address - Fax:206-524-9836
Practice Address - Street 1:444 NORTHEAST RAVENNA BOULVARD
Practice Address - Street 2:SUITE NUMBER 307
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-299-1780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60163144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty