Provider Demographics
NPI:1811278609
Name:TOMOLA, AUDREY (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:TOMOLA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:MAAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15822 26TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7888
Mailing Address - Country:US
Mailing Address - Phone:425-231-0356
Mailing Address - Fax:
Practice Address - Street 1:1010 SOUTH 336TH STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:866-835-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60215255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist