Provider Demographics
NPI:1588191324
Name:BOSTIAN, AMIE LYN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:LYN
Last Name:BOSTIAN
Suffix:
Gender:F
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 1:10507 164TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2769
Mailing Address - Country:US
Mailing Address - Phone:405-245-4694
Mailing Address - Fax:
Practice Address - Street 1:10901 176TH CIR NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7218
Practice Address - Country:US
Practice Address - Phone:425-556-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60429836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist