Provider Demographics
NPI:1952320590
Name:DOSS, DANA BRASWELL (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:BRASWELL
Last Name:DOSS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:BRASWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CARLSBORG
Mailing Address - State:WA
Mailing Address - Zip Code:98324-0040
Mailing Address - Country:US
Mailing Address - Phone:360-504-2033
Mailing Address - Fax:360-504-2569
Practice Address - Street 1:803 CARLSBORG RD
Practice Address - Street 2:SUITE C
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-6710
Practice Address - Country:US
Practice Address - Phone:360-504-2033
Practice Address - Fax:360-504-2569
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADOHLL00001446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA488496001OtherGROUP HEALTH
WA1225467228Medicaid
WABR0899OtherBL CROSS BL SHIELD
WA911945918OtherTAX ID
WA7095920Medicaid
WA126758OtherL&I WORKERS COMP