Provider Demographics
NPI:1831415645
Name:SPOKANE SPEECH LANGUAGE PATHOLOGY
Entity type:Organization
Organization Name:SPOKANE SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:509-710-5084
Mailing Address - Street 1:4407 N DIVISION ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1600
Mailing Address - Country:US
Mailing Address - Phone:509-710-5084
Mailing Address - Fax:
Practice Address - Street 1:4407 N DIVISION ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1600
Practice Address - Country:US
Practice Address - Phone:509-710-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8320574Medicaid