Doctor Name: | MRS. MARIANNA MOUDY |
NPI Number: | 1376896480 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | LL60306687 |
Business Practice Address: | 22443 Se 240th Pl Suite B101 Maple Valley, WA - 980385898 |
Business Phone Number: | 4253584885 |
Business Fax Number: | |
Mailing Address: | 39237 258th Ave Se, ENUMCLAW |
State: | WA |
Postal Code: | 980228867 |
Phone Number: | 8177217350 |
Fax Number: | |
NPI Enumeration Date: | 10/26/2012 |
NPI Last Update Date: | 10/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | LL60306687 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |