Provider Demographics
NPI:1164454393
Name:SADRZADEH, MARYAM (MS SLP)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:SADRZADEH
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 161ST AVE NE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3858
Mailing Address - Country:US
Mailing Address - Phone:425-882-4347
Mailing Address - Fax:
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:SUITE 203
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-882-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA021602 SI00002745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist