Provider Demographics
NPI:1922026905
Name:TULLY-CLINARD, ERIN SIOBHAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:SIOBHAN
Last Name:TULLY-CLINARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:SIOBHAN
Other - Last Name:TULLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:31500 33RD PL SW APT Q103
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5923
Mailing Address - Country:US
Mailing Address - Phone:253-508-9394
Mailing Address - Fax:253-627-5004
Practice Address - Street 1:1220 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-1321
Practice Address - Country:US
Practice Address - Phone:253-403-4437
Practice Address - Fax:253-627-5004
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003121235Z00000X
WALL00004323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4106728OtherBCBS PROVIDER ID NUMBER
TN446506Medicare ID - Type UnspecifiedMEDICARE #, MTN REGION