Provider Demographics
NPI:1285846600
Name:SAMMAMISH CHILDREN'S THERAPY
Entity Type:Organization
Organization Name:SAMMAMISH CHILDREN'S THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANNES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:425-557-6657
Mailing Address - Street 1:3707 PROVIDENCE POINT DR SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6216
Mailing Address - Country:US
Mailing Address - Phone:425-557-6657
Mailing Address - Fax:425-557-4409
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE
Practice Address - Street 2:SUITE C
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:425-557-6657
Practice Address - Fax:425-557-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty