Doctor Name: | MRS. KELLY L ENGEBO |
NPI Number: | 1457411001 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A.,SLP,CCC |
License Number: | LL00002782 |
Business Practice Address: | 106 E 15th St Vancouver, WA - 986633401 |
Business Phone Number: | 3607505850 |
Business Fax Number: | 3607507244 |
Mailing Address: | 208 W 36th St, VANCOUVER |
State: | WA |
Postal Code: | 986601936 |
Phone Number: | 3607505850 |
Fax Number: | 3607507244 |
NPI Enumeration Date: | 12/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | LL00002782 |
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 |