Provider Demographics
NPI:1528043015
Name:SEELY-FADICH, AIMEE C
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:C
Last Name:SEELY-FADICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:C
Other - Last Name:SEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-0350
Mailing Address - Country:US
Mailing Address - Phone:425-358-0956
Mailing Address - Fax:877-481-6931
Practice Address - Street 1:620 N EMERSON AVE
Practice Address - Street 2:STE 204
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6619
Practice Address - Country:US
Practice Address - Phone:509-663-2157
Practice Address - Fax:509-663-7272
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002103231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1044574Medicaid
WAG8900005Medicare PIN
WAG8900006Medicare PIN