Provider Demographics
NPI:1336492347
Name:PEASE, CAREY REBECCA
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:REBECCA
Last Name:PEASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14107 SE 281ST PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-7409
Mailing Address - Country:US
Mailing Address - Phone:253-561-2932
Mailing Address - Fax:
Practice Address - Street 1:14107 SE 281ST PL
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-7409
Practice Address - Country:US
Practice Address - Phone:253-561-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA12125625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA439932EMedicaid