Provider Demographics
NPI:1942814587
Name:BAJWA, ANMOL SINGH (BS, MS)
Entity Type:Individual
Prefix:
First Name:ANMOL
Middle Name:SINGH
Last Name:BAJWA
Suffix:
Gender:M
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28011 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-1825
Mailing Address - Country:US
Mailing Address - Phone:206-992-0545
Mailing Address - Fax:
Practice Address - Street 1:2057 KIBLER AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2731
Practice Address - Country:US
Practice Address - Phone:360-802-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLPI.SI.61082880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist