Provider Demographics
NPI:1508119165
Name:VANLOO, TRESSA LEE (SLP)
Entity Type:Individual
Prefix:
First Name:TRESSA
Middle Name:LEE
Last Name:VANLOO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 HALVERSTICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9528
Mailing Address - Country:US
Mailing Address - Phone:360-354-0730
Mailing Address - Fax:
Practice Address - Street 1:1301 BRIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9355
Practice Address - Country:US
Practice Address - Phone:360-354-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL.00004786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist