Provider Demographics
NPI:1558393785
Name:STACHELSKI, DANIEL J (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:STACHELSKI
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 SILENT CREEK AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9063
Mailing Address - Country:US
Mailing Address - Phone:360-303-9130
Mailing Address - Fax:
Practice Address - Street 1:7125 SILENT CREEK AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9063
Practice Address - Country:US
Practice Address - Phone:360-303-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 0000 3645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12113292OtherASHA
WALL00003914OtherWASHINGTON STATE LICENSE