Provider Demographics
NPI:1730720566
Name:CONAYTUS LLC
Entity type:Organization
Organization Name:CONAYTUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:SUMMER
Authorized Official - Last Name:MCKIM THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:206-486-2906
Mailing Address - Street 1:16720 REDMOND WAY STE G
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4484
Mailing Address - Country:US
Mailing Address - Phone:206-486-2906
Mailing Address - Fax:509-821-9219
Practice Address - Street 1:16720 REDMOND WAY STE G
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4484
Practice Address - Country:US
Practice Address - Phone:206-486-2906
Practice Address - Fax:509-821-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2136947Medicaid