Provider Demographics
NPI:1568248342
Name:LAKE STEVENS SPEECH LANGUAGE AND AAC, PLLC
Entity Type:Organization
Organization Name:LAKE STEVENS SPEECH LANGUAGE AND AAC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMBOISE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:360-870-9147
Mailing Address - Street 1:1706 131ST DR NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9783
Mailing Address - Country:US
Mailing Address - Phone:360-870-9147
Mailing Address - Fax:
Practice Address - Street 1:1709 124TH AVE NE UNIT 997
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1839
Practice Address - Country:US
Practice Address - Phone:360-592-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty