Provider Demographics
NPI:1730228404
Name:BOUMA, KIRSTEN J
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:J
Last Name:BOUMA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10516 SILVERDALE WAY NW STE 110D
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8745
Mailing Address - Country:US
Mailing Address - Phone:877-751-2446
Mailing Address - Fax:360-307-7589
Practice Address - Street 1:10516 SILVERDALE WAY NW STE 110D
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8745
Practice Address - Country:US
Practice Address - Phone:877-751-2446
Practice Address - Fax:360-307-7589
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8410797Medicaid