Provider Demographics
NPI:1093157935
Name:UNDZIUS, ERIK THOMAS (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:THOMAS
Last Name:UNDZIUS
Suffix:
Gender:M
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337B 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3409
Mailing Address - Country:US
Mailing Address - Phone:814-688-6270
Mailing Address - Fax:
Practice Address - Street 1:13010 NE 20TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2034
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:425-644-6295
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60390523235Z00000X
PASL011128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist