NPI 1750856415 · live from the CMS NPI Registry
Abigail Desjardien, M.A. Ccc-Slp, LLC
Clinic/Center, Multi-Specialty in Kenmore, WA. National Provider Identifier 1750856415, active.
NPI record
| NPI | 1750856415 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Clinic/Center, Multi-Specialty 261QM1300X |
| Practice location | 18208 66th Ave Ne Ste 200, Kenmore, WA 98028 |
| Practice phone | 425-419-6199 |
| Mailing address | 19207 63rd Ave Ne, Kenmore, WA 98028 |
| Enumerated | October 9, 2018 |
| Last updated | October 9, 2018 |
| Authorized official | Abigail Desjardien, Speech Language Pathologist |
| Other names | Northshore Pediatric Speech And Language Therapy |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Speech-Language Pathologist, | 235Z00000X | LL60051932 (WA) |
| Clinic/Center, Hearing and Speech | 261QH0700X | — |
| Clinic/Center, Physical Therapy | 261QP2000X | — |
| Clinic/Center, Multi-Specialty primary | 261QM1300X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.