Provider Demographics
NPI:1114312964
Name:SPEECH THERAPY KIRKLAND
Entity Type:Organization
Organization Name:SPEECH THERAPY KIRKLAND
Other - Org Name:DAWN S BLOMBERG, M.S., CCC-SLP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:206-963-6252
Mailing Address - Street 1:9827 NE 120TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6253
Mailing Address - Country:US
Mailing Address - Phone:206-963-6252
Mailing Address - Fax:425-272-4253
Practice Address - Street 1:9827 NE 120TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6253
Practice Address - Country:US
Practice Address - Phone:206-963-6252
Practice Address - Fax:425-272-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7132103Medicaid