Provider Demographics
NPI:1750579553
Name:SPEECH THERAPY ASSOCIATES NORTHWEST
Entity type:Organization
Organization Name:SPEECH THERAPY ASSOCIATES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:OGORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC, SLP
Authorized Official - Phone:360-456-2550
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE M1
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-456-2550
Mailing Address - Fax:
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE M1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-456-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-07
Last Update Date:2007-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty