Provider Demographics
NPI:1932140324
Name:KINIMAKA, MARIZEL BABASA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIZEL
Middle Name:BABASA
Last Name:KINIMAKA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MARIZEL
Other - Middle Name:CAMBRONERO
Other - Last Name:BABASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:15 SOUTH GRADY WAY #336
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-988-3744
Mailing Address - Fax:425-687-2646
Practice Address - Street 1:15 SOUTH GRADY WAY #336
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-988-3744
Practice Address - Fax:425-687-2646
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004034235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist