Provider Demographics
NPI:1396409777
Name:EKMAN, MERISSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:
Last Name:EKMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S CHARLESTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4285
Mailing Address - Country:US
Mailing Address - Phone:505-980-2517
Mailing Address - Fax:
Practice Address - Street 1:333 S CHARLESTON AVE APT C
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4285
Practice Address - Country:US
Practice Address - Phone:505-980-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60845116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist