Provider Demographics
NPI:1437662558
Name:EASTSIDE READING AND LANGUAGE THERAPY, LLC
Entity Type:Organization
Organization Name:EASTSIDE READING AND LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CROSSAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:425-312-2636
Mailing Address - Street 1:9046 NE 195TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2233
Mailing Address - Country:US
Mailing Address - Phone:425-312-2636
Mailing Address - Fax:
Practice Address - Street 1:9046 NE 195TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2233
Practice Address - Country:US
Practice Address - Phone:425-312-2636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-11
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60259143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty