Provider Demographics
NPI:1164292793
Name:CHANG, SSU-YU (SP)
Entity type:Individual
Prefix:
First Name:SSU-YU
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21920 76TH AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7980
Mailing Address - Country:US
Mailing Address - Phone:206-657-6404
Mailing Address - Fax:
Practice Address - Street 1:21920 76TH AVE W STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:206-657-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61466702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist