Provider Demographics
NPI:1275897985
Name:DUPONT SPEECH & LANGUAGE
Entity Type:Organization
Organization Name:DUPONT SPEECH & LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BRINKHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:253-273-2243
Mailing Address - Street 1:1922 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-7743
Mailing Address - Country:US
Mailing Address - Phone:253-273-2243
Mailing Address - Fax:253-912-1477
Practice Address - Street 1:1922 NELSON ST
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-7743
Practice Address - Country:US
Practice Address - Phone:253-273-2243
Practice Address - Fax:253-912-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL00003871OtherDEPT OF HEALTH