Provider Demographics
NPI:1023859972
Name:OLYMPIA SPEECH AND LANGUAGE
Entity type:Organization
Organization Name:OLYMPIA SPEECH AND LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERRITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-990-8051
Mailing Address - Street 1:5611 CEDAR FLATS RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-9415
Mailing Address - Country:US
Mailing Address - Phone:509-990-8051
Mailing Address - Fax:
Practice Address - Street 1:2600 MARTIN WAY E STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4974
Practice Address - Country:US
Practice Address - Phone:360-670-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty