Provider Demographics
NPI:1700357498
Name:VINOKUROVA, YEKATERINA (SLP)
Entity Type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:
Last Name:VINOKUROVA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7683 SE 27TH ST # 127
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2804
Mailing Address - Country:US
Mailing Address - Phone:973-224-4238
Mailing Address - Fax:
Practice Address - Street 1:7683 SE 27TH ST # 127
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2804
Practice Address - Country:US
Practice Address - Phone:973-224-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist