Provider Demographics
NPI:1154776599
Name:KANAKIA, MARIAH CARMEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:CARMEN
Last Name:KANAKIA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:CARMEN
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9742 NE 119TH WAY
Mailing Address - Street 2:APT D218
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8945
Mailing Address - Country:US
Mailing Address - Phone:309-453-7266
Mailing Address - Fax:
Practice Address - Street 1:900 PACIFIC AVE STE 130
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4188
Practice Address - Country:US
Practice Address - Phone:425-258-7352
Practice Address - Fax:425-258-7618
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60712301235Z00000X
WASI 60597418390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program