Provider Demographics
NPI:1588542922
Name:BASILE, MIRANDA (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:BASILE
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 NE 193RD PL
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-3230
Mailing Address - Country:US
Mailing Address - Phone:702-802-9671
Mailing Address - Fax:
Practice Address - Street 1:148 102ND AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6197
Practice Address - Country:US
Practice Address - Phone:425-298-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLP.LL.70008239235Z00000X
WA14510877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist