Provider Demographics
NPI:1326418310
Name:CIRCLE CREEK THERAPY PLLC
Entity Type:Organization
Organization Name:CIRCLE CREEK THERAPY PLLC
Other - Org Name:CIRCLE CREEK THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:253-237-3405
Mailing Address - Street 1:110 2ND ST SW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001
Mailing Address - Country:US
Mailing Address - Phone:253-237-3405
Mailing Address - Fax:253-679-0488
Practice Address - Street 1:110 2ND ST SW
Practice Address - Street 2:SUITE 110
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001
Practice Address - Country:US
Practice Address - Phone:253-237-3405
Practice Address - Fax:253-679-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60578339235Z00000X
WA603544948261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20706086Medicaid