Provider Demographics
NPI:1508858671
Name:SHULENBERGER, KAYLE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAYLE
Middle Name:
Last Name:SHULENBERGER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-0819
Mailing Address - Country:US
Mailing Address - Phone:360-893-6576
Mailing Address - Fax:360-893-6506
Practice Address - Street 1:2301 NE BLAKELEY ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3278
Practice Address - Country:US
Practice Address - Phone:206-522-6830
Practice Address - Fax:206-522-5929
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASH2269OtherREGENCE BLUE SHIELD