Provider Demographics
NPI:1700100658
Name:RETTIG, NANCY DIANE (MS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:DIANE
Last Name:RETTIG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 164TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7604
Mailing Address - Country:US
Mailing Address - Phone:425-629-6302
Mailing Address - Fax:425-629-6303
Practice Address - Street 1:8201 164TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7604
Practice Address - Country:US
Practice Address - Phone:425-629-6302
Practice Address - Fax:425-629-6303
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1962470799OtherNPPES