Provider Demographics
NPI:1477852812
Name:ASSOCIATED TEAM TX, INC
Entity Type:Organization
Organization Name:ASSOCIATED TEAM TX, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:VANDALSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC, SLP
Authorized Official - Phone:360-292-5884
Mailing Address - Street 1:214 E PINE STREET
Mailing Address - Street 2:PO BOX 225
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-0225
Mailing Address - Country:US
Mailing Address - Phone:360-273-0220
Mailing Address - Fax:360-273-5510
Practice Address - Street 1:214 E PINE STREET
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568-0225
Practice Address - Country:US
Practice Address - Phone:360-273-0220
Practice Address - Fax:360-273-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty