Provider Demographics
NPI:1891403010
Name:EMBERSON, ADDISON MARIE (MSP)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:MARIE
Last Name:EMBERSON
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:ADDISON
Other - Middle Name:MARIE
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP
Mailing Address - Street 1:10811 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7108
Mailing Address - Country:US
Mailing Address - Phone:253-854-5660
Mailing Address - Fax:253-854-7025
Practice Address - Street 1:6419 LAKEWOOD DR W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3331
Practice Address - Country:US
Practice Address - Phone:253-531-8873
Practice Address - Fax:253-854-7025
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist