Provider Demographics
NPI:1336499979
Name:ASMUSSEN, ANITA R (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:ASMUSSEN
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POINT FOSDICK DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7819
Mailing Address - Country:US
Mailing Address - Phone:503-789-1638
Mailing Address - Fax:
Practice Address - Street 1:601 S 8TH ST
Practice Address - Street 2:ATT: SPECIAL EDUCATION
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4614
Practice Address - Country:US
Practice Address - Phone:253-571-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60081977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist