Provider Demographics
NPI:1235459272
Name:NEWMAN KENNEDY SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:NEWMAN KENNEDY SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEWMAN-KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-424-9645
Mailing Address - Street 1:1501 PARKER WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2599
Mailing Address - Country:US
Mailing Address - Phone:360-424-9645
Mailing Address - Fax:360-428-3915
Practice Address - Street 1:1501 PARKER WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2599
Practice Address - Country:US
Practice Address - Phone:360-424-9645
Practice Address - Fax:360-428-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001164251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8369167Medicaid