Provider Demographics
NPI:1497074272
Name:BEAR CREEK SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:BEAR CREEK SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-844-1176
Mailing Address - Street 1:18530 156TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8409
Mailing Address - Country:US
Mailing Address - Phone:425-844-1176
Mailing Address - Fax:
Practice Address - Street 1:18530 156TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8409
Practice Address - Country:US
Practice Address - Phone:425-844-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty