Provider Demographics
NPI:1619639457
Name:BALESTRACCI, SUSANNAH EMILY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:EMILY
Last Name:BALESTRACCI
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 1:9606 58TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5808
Mailing Address - Country:US
Mailing Address - Phone:303-475-6755
Mailing Address - Fax:
Practice Address - Street 1:2445 3RD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1923
Practice Address - Country:US
Practice Address - Phone:303-475-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61206834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist