Provider Demographics
NPI:1841360815
Name:MEILAHN, KRISTINE L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:MEILAHN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 STATE AVE STE I PMB 258
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3672
Mailing Address - Country:US
Mailing Address - Phone:360-386-8369
Mailing Address - Fax:360-386-8369
Practice Address - Street 1:19903 164TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7042
Practice Address - Country:US
Practice Address - Phone:425-806-4865
Practice Address - Fax:206-350-8360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7032832Medicaid