Provider Demographics
NPI:1518570159
Name:COLE, KACIE (SLPI)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:SLPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29114 132ND AVE E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7556
Mailing Address - Country:US
Mailing Address - Phone:253-486-7123
Mailing Address - Fax:
Practice Address - Street 1:23123 172ND AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-4713
Practice Address - Country:US
Practice Address - Phone:253-638-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61097401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist