Organization Name: | LAKESIDE CENTER FOR AUTISM |
NPI Number: | 1588802953 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAN STACHELSKI (EXECUTIVE DIRECTOR) |
Mailing Address: | 1871 Nw Gilman Blvd Issaquah |
State: | WA US |
Postal Code: | 980278116 |
Phone Number: | 4256570620 |
Fax Number: | |
NPI Enumeration Date: | 01/23/2009 |
NPI Last Update Date: | 03/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | LL00003914 |
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 |