Abigail Desjardien, M.A. Ccc-Slp, LLC
Clinic/Center, Multi-Specialty in Kenmore, WA. Organization (NPI-2).
NPI number1750856415
StatusActive
Last updated in NPPESOct 9, 2018
Details
- NPI
- 1750856415
- Entity type
- Organization (NPI-2)
- Legal business name
- Abigail Desjardien, M.A. Ccc-Slp, LLC
- Organization subpart
- No
- Enumeration date
- Oct 9, 2018
- Last updated
- Oct 9, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
| 235Z00000X | Speech-Language Pathologist, | LL60051932 | WA | |
| 261QH0700X | Clinic/Center, Hearing and Speech | – | – | |
| 261QP2000X | Clinic/Center, Physical Therapy | – | – |
Other names
- Northshore Pediatric Speech And Language Therapy (Doing Business As)
Practice location
18208 66th Ave Ne Ste 200Kenmore, WA 98028-7949
Phone 425-419-6199 · Fax 855-891-8297
Mailing address
19207 63rd Ave NeKenmore, WA 98028-3329
Phone 360-920-3938
Authorized official
Abigail Desjardien
Speech Language Pathologist
4254196199
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