Provider Demographics
NPI:1679897995
Name:THE AUBIN APHASIA SPEECH AND LANGUAGE CENTER LLC
Entity Type:Organization
Organization Name:THE AUBIN APHASIA SPEECH AND LANGUAGE CENTER LLC
Other - Org Name:THE AUBIN APHASIA CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:206-355-9985
Mailing Address - Street 1:330 MADISON AVE S STE 106
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2544
Mailing Address - Country:US
Mailing Address - Phone:206-355-9985
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON AVE S STE 106
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2544
Practice Address - Country:US
Practice Address - Phone:206-355-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004536261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12123424OtherASHA CERTIFICATION
WALL 00004536OtherSTATE LICENSE