Provider Demographics
NPI:1679243489
Name:SEABURG, ERIN KATHLEEN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KATHLEEN
Last Name:SEABURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-1041
Mailing Address - Country:US
Mailing Address - Phone:509-449-1304
Mailing Address - Fax:
Practice Address - Street 1:18 TWIN LAKES RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:WA
Practice Address - Zip Code:98862-9713
Practice Address - Country:US
Practice Address - Phone:509-996-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP612045992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant