Provider Demographics
NPI:1831447622
Name:WIRTH, CARALEE LYDIA (BA, MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARALEE
Middle Name:LYDIA
Last Name:WIRTH
Suffix:
Gender:F
Credentials:BA, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2330
Mailing Address - Country:US
Mailing Address - Phone:425-268-4118
Mailing Address - Fax:425-953-2534
Practice Address - Street 1:629 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2330
Practice Address - Country:US
Practice Address - Phone:425-268-4118
Practice Address - Fax:425-953-2534
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60269096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist