Provider Demographics
NPI:1861844060
Name:SOUNTHALA, ADINA
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:SOUNTHALA
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 1:6621 S 128TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:371 NE GILMAN BLVD STE 320
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2901
Practice Address - Country:US
Practice Address - Phone:425-427-1075
Practice Address - Fax:425-657-0691
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2023-02-23
Deactivation Date:2021-02-25
Deactivation Code:
Reactivation Date:2021-03-19
Provider Licenses
StateLicense IDTaxonomies
WALL61409786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist