Provider Demographics
NPI:1912078486
Name:WESTERN WASHINGTON UNIVERSITY
Entity Type:Organization
Organization Name:WESTERN WASHINGTON UNIVERSITY
Other - Org Name:SPEECH-LANGUAGE-HEARING CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ASSISTANT III
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:YOUTSEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:360-650-3881
Mailing Address - Street 1:516 HIGH ST
Mailing Address - Street 2:MAIL STOP 9078
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5946
Mailing Address - Country:US
Mailing Address - Phone:360-650-3881
Mailing Address - Fax:360-650-4334
Practice Address - Street 1:516 HIGH ST
Practice Address - Street 2:MAIL STOP 9078
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5946
Practice Address - Country:US
Practice Address - Phone:360-650-3881
Practice Address - Fax:360-650-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7116114Medicaid
WA35859OtherREGENCE BLUE SHIELD
WA7140007Medicaid