Provider Demographics
NPI:1346474731
Name:EVERGREEN SPEECH CLINIC, INC
Entity Type:Organization
Organization Name:EVERGREEN SPEECH CLINIC, INC
Other - Org Name:EVERGREEN SPEECH AND HEARING CLINIC, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MM
Authorized Official - Phone:425-882-4347
Mailing Address - Street 1:8301 161ST AVE NE
Mailing Address - Street 2:#203
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3858
Mailing Address - Country:US
Mailing Address - Phone:425-882-4347
Mailing Address - Fax:425-883-0043
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:#203
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-882-4347
Practice Address - Fax:425-883-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center