Provider Demographics
NPI:1780220319
Name:SAUTHER, MASHALA
Entity type:Individual
Prefix:
First Name:MASHALA
Middle Name:
Last Name:SAUTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MASHALA
Other - Middle Name:
Other - Last Name:GUILBAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2715 S SEABISCUIT DR
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-5108
Mailing Address - Country:US
Mailing Address - Phone:509-481-1040
Mailing Address - Fax:
Practice Address - Street 1:12824 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9408
Practice Address - Country:US
Practice Address - Phone:509-481-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60992903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist