Provider Demographics
NPI:1407355241
Name:SEACRIST, AMY R (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:SEACRIST
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:WHITEHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 PACIFIC AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4168
Mailing Address - Country:US
Mailing Address - Phone:425-258-7311
Mailing Address - Fax:
Practice Address - Street 1:900 PACIFIC AVE FL 1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4168
Practice Address - Country:US
Practice Address - Phone:425-258-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI60816595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist