Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Clinic/center - Multi-specialty |
|---|
| Location | 18208 66th Ave Ne Ste 200, Kenmore, Washington |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1750856415
- Provider Enumeration Date: 10/09/2018
- Last Update Date: 10/09/2018
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1750856415 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 235Z00000X | Speech-language Pathologist | LL60051932 (Washington) | Secondary |
| 261QH0700X | Clinic/center - Hearing And Speech | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
19207 63rd Ave Ne,
Kenmore, WA 98028-3329
Ph: (360) 920-3938 |
18208 66th Ave Ne Ste 200,
Kenmore, WA 98028-7949
Ph: (425) 419-6199 |
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