Provider Demographics
NPI:1174668818
Name:CHILDRENS THERAPY OF KIRKLAND
Entity Type:Organization
Organization Name:CHILDRENS THERAPY OF KIRKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:REPP
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:425-823-7525
Mailing Address - Street 1:9750 NE 120TH PLACE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-823-7525
Mailing Address - Fax:
Practice Address - Street 1:9750 NE 120TH PLACE
Practice Address - Street 2:SUITE 6
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-823-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL0002629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty