Provider Demographics
NPI:1275656001
Name:WOLSWIJK, KRISTI ELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ELAINE
Last Name:WOLSWIJK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 NE 4TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4573
Mailing Address - Country:US
Mailing Address - Phone:206-200-3636
Mailing Address - Fax:
Practice Address - Street 1:401 OLYMPIA AVE NE
Practice Address - Street 2:SUITE 232
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4117
Practice Address - Country:US
Practice Address - Phone:206-200-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist